Neoadjuvant Chemoradiotherapy Using Moderately Hypofractionated Intensity-Modulated Radiotherapy Versus Upfront...

Area of Science:

• Oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Efficacy of neoadjuvant chemoradiotherapy for resectable pancreatic ductal adenocarcinoma (R-PDAC) is not well-established.
• Intensity-modulated radiotherapy (IMRT) is a modern technique for radiation delivery.

Purpose of the Study:

• To evaluate neoadjuvant chemoradiotherapy using intensity-modulated radiotherapy (NAC-IMRT) for R-PDAC.
• To compare NAC-IMRT with upfront surgery (UpS) in R-PDAC patients.

Main Methods:

• Retrospective study of 130 patients with R-PDAC (Eligible set) and 105 patients (As-treated set) between 2013-2021.
• Comparison of oncological outcomes between NAC-IMRT and UpS groups.
• Multivariate analysis to identify independent prognostic factors.

Main Results:

• NAC-IMRT demonstrated superior overall survival (OS) and progression-free survival (PFS) in both Eligible and As-treated sets.
• NAC-IMRT was an independent factor for better OS (HR 0.617, p=0.047).
• NAC-IMRT suppressed local tumor invasion and lymph node metastasis without increasing postoperative complications.

Conclusions:

• NAC-IMRT may provide superior survival outcomes for R-PDAC patients compared to UpS.
• NAC-IMRT is effective and safe, warranting consideration in R-PDAC treatment protocols.