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Background: Recent advances in adjuvant therapy in pancreatic adenocarcinoma (PDAC) prolong survival and increasingly come to encounter long-term chemo-responder without developing new lesions. Is loco-regional therapy such as chemoradiotherapy and/or surgical resection valid for those patients?
Methods: Since April 2010 twenty-eight patients with advanced PDAC (17 locally-advanced, and 11 metastatic) were treated by Gemcitabine with S1 (GS) as a first-line anti-cancer therapy. Reevaluation was performed at 3- and 6-month after administration of GS therapy and loco-regional therapy was considered if new lesions were not developed. Survival was compared between subgroups according to clinical response and additional loco-regional therapy. Pathologic response was investigated among those with surgical resection.
Results: GS therapy was feasible with limited toxicity. Clinical response of GS was no CR, 7 PRs (25%), 8 SDs (29%), and 13 PDs (46%), accounting response rate of 25% and disease control rate of 54%. Among 15 patients without evidence of new lesion 10 patients were received additional loco-regional therapy including 4 resections (2 straightforward, 2 after CRT), 6 CRT with S1. With a median follow up of 17.3 months (7.4-27.2 months) all 10 chemo-responder with additional loco-regional therapy are alive, while a median survival time for 13 non-responders was 8.7 months (Fig 1). Pathologic response of 4 responders with surgical resection was 50%, 85%, 90%, 90%, respectively.
Conclusion: Although non-randomized data with short follow-up period, additional loco-regional therapy for long-term chemo-responder by Gemcitabine with S1 seems feasible option for advanced PDAC.