Dose escalation with a vessel boost in XXXX treated with neoadjuvant chemoradiation.

@entity1 @entity788 @entity137 @entity5 @entity1735
PURPOSE: @entity1 with @entity788 ( @entity788 ) are often treated with neoadjuvant chemoradiation (NACRT) in hopes of downstaging their disease for potential surgical resection. We hypothesized that increasing the radiation dose to the area of the @entity5 abutting the vessel(s) of concern would increase the rate of surgical resection in @entity1 with borderline resectable @entity788 (BRPAC) and locally advanced @entity788 (LAPAC) treated with NACRT. METHODS AND MATERIALS: We retrospectively reviewed consecutive cases of BRPAC and LAPAC treated with NACRT from January 2006 to December 2013, with or without a vessel boost (VB), at a single institution. The primary endpoints were rate of R0/R1 potentially curative surgical resection and acute @entity137 . Univariate analysis with the Fisher exact test was performed to evaluate the effect of each variable. Multiple logistic regression was used to adjust for the following covariates: year of diagnosis, age, sex, @entity1735 antigen 19-9 (CA19-9) level at diagnosis, and BRPAC or LAPAC. RESULTS: Of the 104 @entity1 identified, 22% (n = 23) received a VB (median, 54 Gy; range, 54-64 Gy), and 78% (n = 81) received no boost (median, 50.4 Gy; range, 48.6-52.2 Gy). More @entity1 in the VB group were treated from 2010 to 2013 (P < .001) and with intensity modulated radiation therapy (P = .002). Other baseline characteristics were balanced. After adjustment for covariates, there was a statistical trend toward increased surgical resection in @entity1 who received a VB (odds ratio [OR], 2.77; 95% confidence interval [CI], 0.89-8.57; P = .077). Age (>= 70 years; OR, 0.42; 95% CI, 0.16-1.05; P = .064) and LAPAC (OR, 0.32; 95% CI, 0.09-1.09; P = .068) also trended toward significance. CA19-9 >= 47.9 U/mL (OR, 0.24; 95% CI, 0.08-0.71; P = .010) was significant on multivariate analysis. There was no significant difference in acute or late @entity137 between groups. CONCLUSIONS: In our retrospective series, dose escalation was associated with an improved surgical resection rate in BRPAC and LAPAC @entity1 treated with NACRT, although this improvement was not statistically significant.
