Table 2.
Neoadjuvant radio/chemoradiotherapy in pancreatic cancer.
| Study | Evidence | Protocol | RT Protocol | % R0 | % N0 | Results |
|---|---|---|---|---|---|---|
| PREOPANC1 | prospective | R-PDAC, BR-PDAC: Up-S–6xGem vs. 3xGem–3xGem/RT–Up-S–4xGem |
GTV + ILN 15 × 2.5 Gy |
40% vs. 71% | 23% vs. 53% | Median OS: 14.3 m vs. 15.7 m, DFS: 7.7 m vs. 8.1 m |
| Cloyd | retrospective | R-PDAC: 4–6xGem/5FU-based regimen–S vs. Gem or Cap + RT–S |
3DCRT: GTV + 10 mm + ENI, 10 × 3 Gy or 28 × 1.8 Gy |
79% vs. 91% | 22% vs. 53% | Median OS: 26.4 m vs. 33.6 m |
| A021501 | prospective | BR-PDAC: 8xFOLFIRINOX–S–4xFOLFOX6 vs. 7xFOLFIRINOX–RT–S–4xFOLFOX6 |
SBRT: GTV + 3 mm (5 × 6.6–8 Gy) or IMRT: GTV + 5–10 mm (5 × 5 Gy) |
88% vs. 74% | 47% vs. 47% | Median OS: 29.8 m vs. 17.1 m DFS 15.0 m vs. 10.2 m |
| Jannsen | prospective | RPDAC, BR-PDAC: FOLFIRINOX–S vs. FOLFIRINOX + RT-S |
GTV + ILN or SBRT (25–50.4 Gy) |
88% vs. 97% | 52% vs. 67% | Median OS: 21.6 m vs. 22.4 m |
| ESPAC-5 | prospective | B-PDAC: Up-S vs. NAT-S, GemCap or FOLFIRINOX Cap + RT AT: Gem or GemCap or mFOLFIRINOX |
GTV + ILN (28 × 1.8 Gy) |
14% vs. 30% (18% vs. 18% vs. 37%) | 1-year DFS: 33% vs. 59% |
|
| Murphy | prospective | B-PDAC: 8xFOLFIRINOX.—Cap + RT—S |
GTV + 1 cm ENI short course: Protons 5 × 5 Gy or Photons 10 × 3 Gy or Long course: 28 × 1.8 Gy |
97% | Median OS: 37.7 m 2-years OS: 56% |
Gem—gemcitabine, RT—radiotherapy, Up-S—upfront resection, GTV—gross tumor volume, ENI—elective nodal irradiation, ILN—involved lymph nodes, SBRT—stereotactic body radiotherapy, IMRT—image-guided radiotherapy, OS—overall survival, 5FU—5-fluorouracil, Cap—capecitabine.