Comparative Study Between Gemcitabine-Based and Gemcitabine Plus S1-Based Preoperative Chemoradiotherapy for Localized Pancreatic Ductal Adenocarcinoma, With Special Attention to Initially Locally Advanced Unresectable Tumor.

Abstract

OBJECTIVES:

To evaluate clinical/histological response and prognosis between preoperative gemcitabine-based chemoradiation therapy (G-CRT) and gemcitabine plus S1-based CRT (GS-CRT) for localized pancreatic ductal adenocarcinoma patients according to the 3 resectability groups.

METHODS:

Among 199 patients who had 90% or more relative dose intensity of chemotherapy and completion of radiotherapy preoperatively (G-CRT: 98 and GS-CRT: 101), the subjects were 113 patients (G-CRT: 60 and GS-CRT: 53) who underwent curative-intent resection, and we compared clinical and histological effects between the 2 regimens.

RESULTS:

There is a significant improvement in clinical and histological responses as assessed by reduction rate in tumor size, post-CRT serum level of carbohydrate antigen 19-9, and the ratio of histological high responder according to the Evans grading system in GS-CRT, as compared with G-CRT, which in turn significantly increased R0 resection rate (P = 0.013). These effects of GS-CRT resulted in significant improvement of disease-specific survival (median survival time, 36.0 vs 27.2 months; P = 0.042), especially in patients with unresectable locally advanced disease (36.0 vs 18.1 months, P = 0.014).

CONCLUSIONS:

For localized pancreatic ductal adenocarcinoma patients, GS-CRT, as compared with G-CRT, provides significant improvement in clinical and histological response as well as long-time survival, especially in patients with unresectable locally advanced disease.

• Authors: Taijiro Takeuchi, Shugo Mizuno, Yasuhiro Murata, Aoi Hayasaki, Masashi Kishiwada, Takehiro Fujii, Yusuke Iizawa, Hiroyuki Kato, Akihiro Tanemura, Naohisa Kuriyama, Yoshinori Azumi, Masanobu Usui, Hiroyuki Sakurai, Shuji Isaji
• Journal: Pancreas (Pancreas) Vol. 48 Issue 2 Pg. 281-291 (02 2019) ISSN: 1536-4828 [Electronic] United States
• PMID: 30629019 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Deoxycytidine
• Gemcitabine

Topics

• Adenocarcinoma (therapy)
• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carcinoma, Pancreatic Ductal (drug therapy)
• Chemoradiotherapy (methods)
• Deoxycytidine (administration & dosage, analogs & derivatives)
• Disease-Free Survival
• Female
• Humans
• Male
• Middle Aged
• Pancreatic Neoplasms (therapy)
• Prognosis
• Gemcitabine