Abstract
We examined the effect and importance of neoadjuvant chemoradiotherapy (NACRT) and radical resection for advanced pancreatic body cancer with no distant metastasis. Since 2011, concomitant oral administration of TS1 and 50-Gy preoperative irradiation by three-dimensional conformal radiotherapy have been performed for pancreatic cancer. The subjects were 11 patients with cIVa tumors. We followed the guidelines of the National Comprehensive Cancer Network (NCCN). The 11 subjects included 2 patients with resectable cancer, 6 patients with borderline resectable cancer, and 3 patients with unresectable cancer. After NACRT, 1 subject with resectable cancer underwent resection, and the other patient could not receive surgery, and thus continued to receive chemotherapy. Among the 6 patients with borderline cancers, 4 patients underwent resection, and 2 patients continued to receive chemotherapy after NACRT due to development of hepatic metastasis. For 1 patient with unresectable cancer, chemotherapy was continuously performed because CT also suggested that the cancer would be unresectable. However, since a partial response of 38% reduction was confirmed after additional administration of TS1, distal pancreatectomy with en-bloc celiac axis resection was performed, and no residual tumor (R0) could be achieved. In 50% of the patients whose cancer could be removed (3 out of 6 patients), downstaging was observed. In the evaluation of residual tumor, R0 was confirmed for 4 patients, and pathological residual tumor (R1) was confirmed for 2 patients, including 1 patient with residual tumor in the mesenteric left plexus avulsion area and 1 patient with residual tumor in the pancreatic cut end.
