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Purpose <p>Adenocarcinoma of pancreas is a lethal malignancy with multimodality treatment used in various combinations to improve survival. This study aimed to evaluate resectability&#xa0;rates, R0 resection status, and local progression-free survival (LPFS) in borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) patients treated with neoadjuvant chemotherapy (NACT) followed by either stereotactic body radiotherapy (SBRT) or conventional chemoradiation (CRT).</p> Methods <p>In this single institution prospective study, 20 pancreatic cancer patients (15 LAPC and 5 BRPC) received NACT (modified FOLFIRINOX or Gemcitabine with nab-paclitaxel), followed by random assignment (1:1) to SBRT (33–42 Gy/5–6 fractions) or CRT (45 Gy in 25 fractions with Capecitabine). After restaging, patients who were eligible underwent surgery, while others continued chemotherapy. Toxicity, quality of life (QoL), and haematological parameters (NLR, PLR) were assessed.</p> Results <p>Resectability was observed in 15% of patients, all from the SBRT arm. All patients who underwent resection were LAPC at diagnosis. The mean overall survival (OS) and local progression-free survival (LPFS) in the SBRT group were 21.8 months and 14&#xa0;months, respectively, with a median OS of 15 months and median LPFS of 11 months. In comparison, the CRT group had a mean OS and LPFS of 13&#xa0;months and 8.6 months, respectively, with a median OS of 12 months and median PFS of 7 months. One-year OS was 80% in the SBRT arm and 45% in the CRT arm. QOL improved in both arms, with better scores in the SBRT group. SBRT had no grade 3 or 4 toxicities. Lower NLR and PLR values correlated with better outcomes.</p> Conclusion <p>SBRT showed superior resectability, survival outcomes, and&#xa0;QoL&#xa0;compared to CRT in patients with BRPC and LAPC. However, due to the study’s small sample size and single-centre design, these findings are hypothesis-generating and warrant validation in larger multicentre trials.</p>

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A Randomized Controlled Trial of Stereotactic Body Radiation Therapy Versus Chemoradiation Following Induction Chemotherapy in Borderline Resectable and Locally Advanced Pancreatic Cancer

  • 期刊论文

  • 发表日期：

    2025年10月27日

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  • Vandana Thakur,
  • Divya Khosla,
  • Gaganpreet Singh,
  • Rakesh Kapoor,
  • Rajesh Gupta,
  • Mahendra Kumar,
  • Divyesh Kumar,
  • Surinder S. Rana,
  • Harjeet Singh,
  • Jimil Shah,
  • Renu Madan,
  • Shikha Goyal,
  • Arun S. Oinam

摘要

Purpose

Adenocarcinoma of pancreas is a lethal malignancy with multimodality treatment used in various combinations to improve survival. This study aimed to evaluate resectability rates, R0 resection status, and local progression-free survival (LPFS) in borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) patients treated with neoadjuvant chemotherapy (NACT) followed by either stereotactic body radiotherapy (SBRT) or conventional chemoradiation (CRT).

Methods

In this single institution prospective study, 20 pancreatic cancer patients (15 LAPC and 5 BRPC) received NACT (modified FOLFIRINOX or Gemcitabine with nab-paclitaxel), followed by random assignment (1:1) to SBRT (33–42 Gy/5–6 fractions) or CRT (45 Gy in 25 fractions with Capecitabine). After restaging, patients who were eligible underwent surgery, while others continued chemotherapy. Toxicity, quality of life (QoL), and haematological parameters (NLR, PLR) were assessed.

Results

Resectability was observed in 15% of patients, all from the SBRT arm. All patients who underwent resection were LAPC at diagnosis. The mean overall survival (OS) and local progression-free survival (LPFS) in the SBRT group were 21.8 months and 14 months, respectively, with a median OS of 15 months and median LPFS of 11 months. In comparison, the CRT group had a mean OS and LPFS of 13 months and 8.6 months, respectively, with a median OS of 12 months and median PFS of 7 months. One-year OS was 80% in the SBRT arm and 45% in the CRT arm. QOL improved in both arms, with better scores in the SBRT group. SBRT had no grade 3 or 4 toxicities. Lower NLR and PLR values correlated with better outcomes.

Conclusion

SBRT showed superior resectability, survival outcomes, and QoL compared to CRT in patients with BRPC and LAPC. However, due to the study’s small sample size and single-centre design, these findings are hypothesis-generating and warrant validation in larger multicentre trials.