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• W3208592989 abstract "Introduction: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer where radical surgery is currently the only curative option. Outcomes after curative surgery for resectable cancer are still suboptimal. Patients with borderline (BRPC) and locally advanced (LAPC) pancreatic cancers have poor outcomes following surgery and the majority don't go on to receive adjuvant therapy. We studied the clinical outcomes of aggressive neoadjuvant chemotherapy for BRPC and LAPC. Aim: Evaluate the efficacy of NAT in BRPC and LAPC, subsequent surgical conversion rate at our centre. Methods: Patients with borderline and locally advanced pancreatic ductal adenocarcinoma between 2016 and 2019 were retrieved from institutional pancreatic tumour database. Patients with IPMN, MCN, periampullary cancers and metastatic pancreatic cancer were excluded. All patients with BRPC, LAPC received neoadjuvant chemotherapy and chemoradiotherapy in selected patients. The data was analysed using descriptive statistical analysis including uni and multivariate analysis where applicable. Response to neoadjuvant treatment was evaluated. DFS and OS were estimated using kaplan meier curves. Mortality rates in the cohort were estimated. Results: We included 109 patients with a mean age of 66.2 years. Mean tumour size was 31.19mm. 20 patients (18.3%) were categorised into T4 disease, 53 (48.6%) in T3. Mean CA 19-9 was 787.75 in BRPC and 1013.21 in LAPC patients. 54 (49.5%) patients had BRPC and 42 (38.5%) had LAPC. 89 patients received chemotherapy. Consolidative chemoradiotherapy was given to 58 (53.2%) patients. Curative Surgery was performed in 23 (21.1%) patients. R0 rate was 64.7% in BRPC and 50% in LAPC groups. Progressive disease was seen in 43.1% (22) BRPC and 43.7% (27) LAPC patients. Palliative surgery was performed in 15 (13.76%) patients. Median overall survival amongst operated was 22 months and 12 months for BRPC and LAPC respectively. The overall mortality due to PDAC was 50.4%, patient undergoing curative surgery had a mortality rate of 2.8% at our centre. Conclusion: Neoadjuvant chemotherapy with or without radiotherapy is efficacious in converting unresectable cancer into resectable disease, it may also prevent disease progression, higher resection rates and prolonged survival can be achieved. Curative surgery after neoadjuvant therapy is feasible in patients with BRPC and LAPC. Trials investigating optimal treatment strategy for BRPC and LAPC are needed." @default.
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• W3208592989 date "2021-01-01" @default.
• W3208592989 modified "2023-09-26" @default.
• W3208592989 title "Role of neoadjuvant treatment in borderline and locally advanced pancreatic ductal adenocarcinoma: the leeds experience" @default.
• W3208592989 doi "https://doi.org/10.1016/j.hpb.2021.08.350" @default.
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