Total Neoadjuvant Approach for Borderline Resectable and Locally Advanced Pancreatic Adenocarcinoma-UK Tertiary...

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Pancreatic ductal adenocarcinoma (PDAC) has poor survival rates.
• Radiological staging for PDAC (borderline resectable vs. locally advanced) can be imprecise.
• Neoadjuvant therapy (NAT) is used to improve outcomes in PDAC.

Purpose of the Study:

• To compare outcomes for borderline resectable (BR) and locally advanced (LA) PDAC treated with total neoadjuvant therapy (NAT).
• To evaluate the impact of systemic anti-cancer therapies (SACT) with or without chemoradiation (CRT) followed by resection.

Main Methods:

• Retrospective analysis of 165 PDAC patients (44 BR, 121 LA) treated with NAT (SACT +/- CRT) and surgery.
• Comparison of overall survival (OS) and resectability rates between BR and LA groups.
• Analysis of factors influencing survival, including resection margin status.

Main Results:

• No significant difference in median OS between BR and LA PDAC (18 vs. 16 months).
• Resection was possible in 47.7% of BR and 18.1% of LA patients post-NAT.
• R0 resection (negative margins) significantly improved OS compared to R1 (positive margins) in resected patients (47 vs. 22 months).

Conclusions:

• Total NAT strategies yield similar survival outcomes for BR and LA PDAC.
• Findings challenge traditional radiological staging for treatment decisions.
• Achieving margin-negative resection is crucial for long-term survival in BR/LA PDAC.