- Neoadjuvant chemoradiotherapy (nCRT) shows superiority to up-front surgery in secondary outcomes, but not OS, in resectable or borderline resectable pancreatic ductal adenocarcinoma (PDAC).
Why this matters
- This study is the first randomized clinical trial of nCRT in this population.
- Randomized, phase 3 clinical trial (16 centers, N=246).
- Funding: Dutch Cancer Society.
- No significant difference in median OS between the nCRT and up-front surgery groups (16.0 vs 14.3 months; P=.096).
- The nCRT group had better secondary outcomes:
- R0 resection rate: 71% vs 40% (P<.001>
- Median DFS: HR, 0.73 (P=.032).
- Median locoregional failure-free interval (LFFI): HR, 0.56 (P=.0034).
- Pathologic lymph nodes: 33% vs 78% (P<.001>
- Perineural invasion: 39% vs 73% (P<.001>
- Venous invasion: 19% vs 36% (P=.024).
- OS: 17.6 vs 13.2 months (HR, 0.62; P=.029).
- DFS: 6.3 vs 6.2 months (HR, 0.59; P=.013).
- LFFI: 27.7 vs 11.8 months (HR, 0.54; P=.022).
- Possibly underpowered.