Preoperative XXXX and concurrent radiation for borderline resectable pancreatic cancer.

@entity1 @entity416 @entity5 @entity1124
BACKGROUND: @entity1 with borderline resectable @entity1124 ( @entity1124 ) represent a high-risk group of @entity1 due to @entity5 or @entity1 -related characteristics. The optimal management of these @entity1 has not been fully defined. MATERIALS AND METHODS: All @entity1 undergoing evaluation for @entity1124 between 2005 and 2008 were identified. Clinical, radiographic, and pathological data were retrospectively reviewed. @entity1 were staged as borderline resectable using the M.D. Anderson @entity5 Center (MDACC) classification. RESULTS: A total of 170 @entity1 with @entity1124 were identified, 40 with borderline resectable disease. Of these, 34 borderline resectable @entity1 (85%) completed neoadjuvant therapy and were restaged; pancreatic resection was completed in 16 @entity1 (46%). Also, 8 @entity1 completed 50  Gy of radiation in 28 fractions in 6  weeks, whereas 8 @entity1 received 50  Gy in 20 fractions in 4  weeks plus chronomodulated @entity416 . An R0 resection was achieved in 12 of the 16 @entity1 (75%). Also, 5 @entity1 (63%) treated in 20 fractions had >90% pathologic response versus 1 (13%) treated in 28 fractions (P  <  .05). Borderline resectable @entity1 completing surgery had similar survival to @entity1 with resectable disease who underwent surgery. @entity1 receiving accelerated fractionation radiation had improved survival compared with @entity1 treated with standard fractionation protocol. CONCLUSIONS: A neoadjuvant approach to borderline resectable @entity1124 identifies @entity1 who are most likely to benefit from pancreatic resection. Preoperative @entity416 -based chemoradiation is an effective, well-tolerated treatment for these @entity1 . Neoadjuvant therapy for borderline resectable @entity1124 warrants further investigation using treatment schedules that can safely intensify irradiation dose.
