| セッション情報 | The 4th International ForumII Challenge to the pancreatic and biliary cancers 3. Pancreatic cancer―Challenge to the better treatment |
|---|---|
| タイトル | IFII-3-4：Preoperative chemoradiotherapy for borderline resectable pancreatic ductal adenocarcinoma |
| 演者 | Isaji Shuji（Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University, Japan） |
| 共同演者 | Kishiwada Masashi（Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University, Japan）, Sato Rie（Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University, Japan） |
| 抄録 | Background：Chemoradiotherapy prior to surgery（CRT-S）for pancreatic ductal adenocarcinoma（PDAC）may provide for early treatment of micrometastatic disease, allows for identification of the patients with metastatic disease at the time of reassessment, and may increase R0 resection rate, resulting in reduced risk of local tumor recurrence. The aim of the present study was to evaluate the impact of preoperative chemoradiotherapy for borderline resectable（BR）PDAC at our institution, by comparing the outcome of multi-institutional survey of BR-PDAC by the Japanese Society of Pancreatic Surgery（JSPS）. Patients and Methods：（1）We used the data on 624 BR-PDAC（pancreatic head/body）patients obtained by JPSP multi-institutional survey in 2010（J Hepatobiliary Pancreat Sci. 2013）.（2）Between February 2005 and March 2013 at our institution, we had enrolled 183 patients with cytologicaly/histologicaly proven PDAC who agreed to undergo our CRT-S protocol：3-dimensional conformation radiotherapy（45 to 50.4 Gy/25 to 28 fractions）and chemotherapy（gemcitabine, or gemcitabine + oral S-1）. These patients were retrospectively classified into three respectability groups：resectable（R）, BR and locally unresectable（UR）, according to NCCN guideline. Results：（1）Among 624 patients, 539（86.4%）underwent curative-intent resection, showing R0 resection rate of 65.9%. The 3-year survival rate was 16.1% in all patients, and 22.8% in patients with resection.（2）The 183 patients were reclassified as R in 18 patients, BR in 87 and UR in 78. In 87 BR patients, 69（79.3%）underwent curative-intent resection, showing R0 resection rate of 85.5%. The 3-year survival rate was 33.0% in all patients, and 35.0% in patients with resection. When CA19-9 reduction rate after CRT was compared in the whole BR patients, the 3-year survival rate was significantly higher in the patients with reduction rate of more than 50% than in those with less than 50%：42.8% vs. 9.7%（p=0.0018）. Conclusion：Preoperative CRT for BR-PDAC enhances R0 resection rate, which may improve long-term prognosis. |
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