Optimizing neoadjuvant chemoradiation in resectable and borderline resectable pancreatic cancer: Evidence-based insights

Table 2 Studies including neoadjuvant chemoradiation in resectable and borderline resectable pancreatic cancer

Ref.	Period of study	Type of study	Number of patients (n)	Intervention	Resection rate	Category	R0	N0 resection	Survival (months)	Post-surgical complications
Combination of chemotherapy and radiotherapy in resectable pancreatic cancer
Golcher et al[41]	2003-2009	Phase II RCT, multicentre, randomized	n = 66; 2 arms	Neoadj. Gemcitabine/cisplatin	57.5% vs 70% (P = 0.31)	RPC	48% vs 52% (P = 0.81)	30% vs 39% (P = 0.44)	Median OS-14.4 vs 17.4 (P = 0.96)	97% vs 66%
			Sur (n = 33)	Based CRT (50.4-55.8 Gy)-Sur-adj. Gemcitabine
			Neoadj-Sur (n = 33)
Casadei et al[52]	2007-2014	RCT, single centre, randomized	n = 38; 2 arms	Neoadj. Gemcitabine-based CRT	75.0% vs 61.1%	RPC	25.0% vs 39% (P = 0.489)	10% vs 28%	Median OS-19.5 vs 22.4 (P = 0.973)	45.0% vs 55.6%, P = 0.746
			Sur (n = 20)	(54 Gy)-Sur-adj. Gemcitabine
			Neoadj-Sur (n = 18)
Combination of chemotherapy and radiotherapy in both resectable and borderline resectable pancreatic cancer
Versteijne et al[55]	2013-2017	Phase III RCT, multicentre, randomized	n = 246; 2 arms	Neoadj. Gemcitabine-based CRT	72% vs 61% (P = 0.058)	RPC and BRPC	40% vs 71% (P < 0.001)	78% vs 33% P < 0.001	Median OS: 14 vs 16 months (P = 0.07)	36% vs 41% (P = 0.44)
			Sur (n = 127)	(36 Gy)-Sur-adj. Gemcitabine
			Neoadj-sur (n = 119)
Combination of chemotherapy and radiotherapy in borderline resectable pancreatic cancer
Jang et al[42]	2012-2014	Phase 2/3 RCT, multicentre, randomized	n = 50; 2 arms	Neoadj. Gemcitabine-based CRT	63% vs 78%	BRPC	26.1% vs 52% (P = 0.004)	70.6% vs 16.7%	Median OS: 12 vs 21 (P = 0.028)	23.6% vs 16.8%
			Sur (n = 23)	(54 Gy)-Sur-adj. Gemcitabine					2-YR OS: 26% vs 41%
			Neoadj-sur (n = 27)
Ghaneh et al[63]	2014-2018	Phase II RCT, multicentre, randomized	n = 90	Neoadj. Gemcitabine + capecitabine	(Combined neoadjuvant group vs Sur)	BRPC	(Combined neoadjuvant group vs Sur)	NR	(Combined neoadjuvant group vs Sur)	50% vs 38% (P = 0.54)
			Sur (n = 33)	Neoadj. mFOLFIRINOX	68% vs 55% (P = 0.33)		14% vs 23% (P = 0.49)		1-year OS = 39% vs 78% vs 84% vs 60%, 1-year DFS = 33% and 59% (P = 0.016)
			Neoadj. Gemcitabine/capecitabine (n = 20)	Neoadj. Capecitabine-based CRT (50.4 Gy)
			Neoadj. mFOLFIRINOX (n = 20)	All of them received adj. Gemcitabine or adj. 5-FU/FA after Sur
			Neoadj capacibine-based CRT (n = 17)
Katz et al[57]	2013-2014	Phase II, multicentre, single-arm	n = 22	Neoadj. mFOLFIRINOX)-capecitabine-based	68%	BRPC	93%	NR	Median OS: 22 months	53%
				CRT (50.4 Gy)-Sur-adj. Gemcitabine
Murphy et al[60]	2012-2016	Phase II, single centre single-arm	n = 48	FOLFIRINOX-short-course (25Gy/5 fractions) or long-course (50.4 Gy-58.8 Gy)	65%	BRPC	97%	NR	Median OS: 38 months	NR
				Capecitabine-based CRT-Sur
Takahashi et al[64]	2019	Phase II single-arm, multicentre	n = 52	Neoadj. S1 (a prodrug of 5-fluorouracil)-based	-	BRPC	52%	NR	Median OS: 30.8 months	7.5%
				CRT (50.4 Gy)

RCT: Randomized controlled trial; Sur: Surgery; Neoadj: Neoadjuvant; Adj: Adjuvant; NR: Not reported; CRT: Chemoradiotherapy; BRPC: Borderline resectable pancreatic cancer; RPC: Resectable pancreatic cancer; DFS: Disease-free survival; OS: Overall survival; YR: Year survival; 5-FU/FA: Fluorouracil with folinic acid; mFOLFIRINOX: modified Fluorouracil with folinic acid, irinotecan, oxaliplatin.