Comparison between Neoadjuvant Chemoradiotherapy and Chemotherapy for Patients with Resectable Pancreatic Cancer

Clinical trials of neoadjuvant therapy for resectable pancreatic cancer are being conducted worldwide. The present study aimed to evaluate the treatment effect of neoadjuvant chemoradiotherapy (NACRT) compared with that of neoadjuvant chemotherapy (NAC) for patients with resectable pancreatic cancer.

Patients with resectable pancreatic cancer who underwent surgical resection following NACRT or NAC between December 2011 and March 2017 were included in this study. Clinicopathological factors were compared using propensity score-matched analyses.

A total of 347 patients were included; 170 underwent NACRT, and 177 underwent NAC. In the propensity score-matched cohort, the posttreatment CA19-9 level was significantly lower in the NACRT group. Pathological lymph node metastasis was significantly less and pathological tumor response was better in the NACRT group. Median overall survival was comparable (56.3 months in NACRT group and 50.5 months in NAC group). Disease-free survival did not differ significantly, but local recurrence was significantly less in the NACRT group. In the whole cohort, multivariate analysis showed that portal vein resection, transfusion, residual cancer, and absence of adjuvant chemotherapy were independent factors associated with poor overall survival. Logistic regression analysis showed that NAC, combined portal vein resection, and margin-positive resection were risk factors for local recurrence.

Neoadjuvant chemoradiotherapy showed a stronger local control effect than NAC for resectable pancreatic cancer, but overall survival and disease-free survival were not significantly different between treatment groups. The present study suggests that more effective systemic treatment, as well as local control, is crucial even in patients with resectable pancreatic cancer.