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Neoadjuvant Chemoradiotherapy Demonstrates a Long-Term Survival Benefit in Pancreatic Cancer Patients when Compared to Upfront Surgery

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Past randomized control trials comparing perioperative treatments in pancreatic cancer have indicated that long-term follow-up is required to detect a significant survival difference. This study reported the long-term results of the PREOPANC trial, where patients were randomly assigned to receive neoadjuvant gemcitabine-based chemoradiotherapy before surgery and adjuvant gemcitabine, or upfront surgery and adjuvant gemcitabine. The primary endpoint was overall survival (OS) by intention-to-treat (ITT) analysis. Efficacy was also compared across resectable and borderline resectable pancreatic cancer patients.

While median survival and a follow-up of 27 months showed no significant survival benefit, the 3-year and 5-year follow-ups indicated a clinically relevant increase in OS. Superiority was preserved across resectable and borderline resectable disease subgroups of comparable baseline characteristics.  Resection rates were compared between both groups and a lower proportion of patients in the neoadjuvant group underwent resection. Patients who forwent resection presented with an aggressive and likely metastatic cancer during neoadjuvant therapy, whereby resection would not have helped and was thus avoided. Read more . . . 

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