Dutch delight.

Headline: Pre-op chemoradiation improves overall survival (OS) over upfront surgery for borderline resectable pancreatic cancer.
The Study: Don’t feel like this one is really news? This time it’s based on data from the Dutch PREOPANC-1 trial that was both prospective and randomized, two features pretty hard to come by on this topic. 242 patients were randomized to upfront surgery versus neoadjuvant 36 Gy / 15 with concurrent and sequential weekly gemcitabine x 6 (to start on day one of radiation) followed by surgery. The primary endpoint of OS was significantly better with neoadjuvant therapy, improved from 13.5 → 17 months. Probably because margin-negative resection rates were doubled from 31 → 65%, which was mirrored in a doubling of OS from 17 → 30 months among the roughly two-thirds of patients who actually made it to resection.
Bottom Line: Coming to NCCN guidelines near you is a category 1 recommendation for neoadjuvant chemoradiation for all borderline resectable pancreatic cancers. TBA: the best chemoradiation regimen because FOLFIRINOX and SBRT aren’t going down without a fight. | Van Tienhoven, ASCO 2018


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