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Neoadjuvant Therapy And Local Recurrence In Pancreatic Adenocarcinoma

Sarah E. Greer, Thomas A. Colacchio, John E. Sutton, Jr., J. Marc Pipas, Bassem I. Zaki, Richard J. Barth, Jr.
Dartmouth-Hitchcock Medical Center, Lebanon, NH

Objective: To compare the effect of neoadjuvant versus adjuvant chemoradiotherapy on local recurrence after resection of pancreatic adenocarcinoma.
Design: Retrospective case-control study.
Setting: Tertiary-care academic institution.
Patients: Ninety three patients with pancreatic adenocarcinoma who underwent pancreatic resection between 1993 and 2004.
Interventions: Data regarding neoadjuvant or adjuvant chemotherapy and radiation, resectability by CT criteria, and type of surgical resection was collected.
Main Outcome Measure: Local recurrence.
Results: Of 93 patients with pancreatic adenocarcinoma who underwent surgical resection, 19 (20%) had no additional treatment, 35 (38%) were treated preoperatively with neoadjuvant chemoradiotherapy, and 39 (42%) underwent adjuvant chemoradiotherapy. There was a marked bias towards more locally advanced tumors in patients selected to receive neoadjuvant therapy. Based on the initial CT scan, the percentage of patients with unresectable, borderline resectable, or resectable tumors in the neoadjuvant group was 37%, 31%, and 31% respectively, compared to 3%, 20%, and 77% in the adjuvant group. Nevertheless, local recurrences were observed in only 2 of 35 patients (6%) receiving neoadjuvant therapy compared to 13 of 39 patients (33%) receiving adjuvant therapy. For those patients with tumors determined to be resectable on initial CT scan, local recurrences were observed in only 1 of 11 patients (9%) in the neoadjuvant group compared to 9 of 30 patients (30%) in the adjuvant therapy group.
Conclusions: Neoadjuvant chemoradiotherapy is associated with improved local tumor control in patients undergoing resection for pancreatic carcinoma.

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