Outcomes in Locally Advanced Pancreatic Cancer After Induction Ablative Radiation Therapy and Resection

Ablative-dose radiotherapy (A-RT) may result in durable local control and encouraging survival for patients with locally advanced pancreatic cancer (LAPC). A subset of patients with LAPC are eligible for exploration after completion of induction chemotherapy and A-RT. Outcomes for this subset of patients are yet to be described.

This was a single-institution retrospective analysis of patients who had LAPC treated with induction chemotherapy and A-RT (≥98 Gy biologically effective dose using 15 to 25 fractions in 3- to 4.5-Gy/fraction), then subsequently underwent surgical exploration.

During a 6-year period, 34 patients with LAPC underwent exploration after induction chemotherapy and A-RT. Chemotherapy was given before A-RT to all the patients, with the majority receiving FOLFIRINOX (94 %). The median time to exploration after completion of A-RT was 75 days. Pancreaticoduodenectomy was the most frequent procedure (n = 18), followed by distal pancreatectomy (n = 7), and resection was aborted in nine patients (26 %) after discovery of distant (n = 6) or locally unresectable (n = 3) disease. Vascular resection or divestment was required for 56 % of the patients. There were no postoperative pancreatic fistulae. However, clinically significant ascites were observed in 36 % of the resected patients. A major pathologic response was observed in 17 % of the resected specimens upon final pathologic review. Postoperative mortality within 90 days occurred for two patients (5.9 %). The median overall survival for the entire cohort was 31 months from the date of diagnosis and 24 months from completion of A-RT.

Resection of LAPC is feasible for a select cohort of patients after A-RT, with encouraging 2-year overall survival.