Quantum mechanics

Chemoradiotherapy

Surgery

Pancreatic cancer

Radiation therapy

Physics

Overall survival

Gemcitabine

Internal medicine

Clinical endpoint

Chemotherapy

Oncology

Medicine

Term (time)

Cancer

Randomized controlled trial

Purpose: The PREOPANC trial suggested a benefit of preoperative chemoradiotherapy in patients with resectable (RPC) and borderline resectable pancreatic cancer (BRPC). Long-term results are presented. Methods: In this Dutch multicenter phase III trial, patients with RPC or BRPC were included. Patients were randomized to either preoperative chemoradiotherapy (three cycles of full dose gemcitabine 1000 mg/m2 weekly, the second combined with 15 times 2.4 Gy radiotherapy), followed by surgery and four cycles of adjuvant gemcitabine, or immediate surgery followed by six cycles of adjuvant gemcitabine. Primary endpoint was overall survival by intention-to-treat (ITT). Results: Between April 2013 and July 2017, 246 eligible patients were randomized in 16 Dutch centers; 119 to preoperative chemoradiotherapy and 127 to immediate surgery. At the time of the present analysis (median follow up 59 months), 93 patients (78%) in the preoperative chemoradiotherapy arm and 117 patients (92%) in the immediate surgery arm had died. Overall survival by ITT was significantly longer after preoperative chemoradiotherapy, with a five-year survival of 20.5% after preoperative treatment versus 6.5% after immediate surgery (HR 0.73; 95% CI 0.56 to 0.96; p = 0.025). Secondary outcomes such as disease-free survival, locoregional failure-free interval and pathological outcomes were also significant better after preoperative chemoradiotherapy. Conclusion: This nationwide, multicenter study is the first completed phase III trial demonstrating that preoperative gemcitabine-based chemoradiotherapy improves long term overall survival compared with immediate surgery in patients with RPC or BRPC.

Improved Overall Survival in Pancreatic Cancer with Preoperative Chemoradiotherapy: Long-term Results of the PREOPANC Trial