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Introduction. The results of surgical therapy alone for pancreatic cancer are disappointing. We have reported that surgical resection following neo-adjuvant chemoradiation therapy (NACRT) can be associated with the higher rate of R0, and with the lower rate of metastastic lymph nodes, resulting in improved prognosis of patients with T3/4 pancreatic cancer (Pancreas 2009 and 2011 in press). However, there is no consensus on the regimen of NACRT for pancreatic cancer. The aim of this study is to explore the short-term results of the new regimen of NACRT using S-1 followed by surgical resection.
Patients. Among 103 consecutive patients with potentially resectable pancreatic cancer between January 2006 and September 2010, 43 patients were classified as adjuvant group between Jan. 2006 and Sep 2008, and 34 patients who underwent NACRT between Oct 2008 and Sep 2010 were classified as NACRT group. The regimen of NACRT was consisted of S-1 (orally twice daily, 5days in a week, 80mg/m2/day) and concurrent radiotherapy (total of 50.4 Gy). The primary endpoint was the frequency of pathological curative resection (R0). All patients who underwent pancreatectomy were planned to receive adjuvant chemotherapy.
Results. The overall response rate and disease control rate in NACRT group were 18% and 88.0%, respectively. There was no difference in resection rate between NACRT and adjuvant groups (30/34 vs 36/43). Other organ resection including vascular resection was done for 17 of 36 patients in adjuvant group and for 19 of 30 patients in NACRT group. The primary end point analysis of this study demonstrated that in accordance with our study hypothesis, NACRT followed by surgical resection improved R0 rate in NACRT group compared with adjuvant group (28/30 vs 21/36, p=0.005). The number of metastatic lymph nodes in NACRT group was significantly lower than in adjuvant group (p=0.0363). On the comparisons of extension of metastatic lymph nodes, the frequency of N0/1 in NACRT group was also higher than in adjuvant group (p=0.041). There were no significant differences in mortality and morbidity except intractable ascites between two groups. The rate of intractable ascites in NACRT group was significantly higher than in adjuvant group (8/22 vs 2/34, p=0.035). The frequency of local relapse in NACRT group was significantly lower than in adjuvant group at 1year after surgical resection (0% vs 26%, p=0.021).
Conclusion. NACRT using S-1 can improve the rate of pathologically curative resection and the number and extension of metastatic lymph nodes in patients with T3/4 pancreatic cancer, resulting in better local control.