Annals of Surgical Oncology

, Volume 21, Issue 2, pp 662–669 | Cite as

Neoadjuvant Chemoradiation and Duration of Chemotherapy Before Surgical Resection for Pancreatic Cancer: Does Time Interval Between Radiotherapy and Surgery Matter?

  • Kathryn T. Chen
  • Karthik Devarajan
  • Barton N. Milestone
  • Harry S. Cooper
  • Crystal Denlinger
  • Steven J. Cohen
  • Joshua E. Meyer
  • John P. Hoffman
Pancreatic Tumors



Neoadjuvant chemoradiation and chemotherapy provided for borderline or locally advanced, potentially resectable pancreatic adenocarcinoma improves resectability rates. Response to therapy is also an important prognostic factor. There are no data in the literature regarding optimal time interval or duration of chemotherapy after chemoradiation before surgery, and pathologic response rates. Using our database, we evaluated these relationships and the effect on overall and progression-free survival.


We retrospectively analyzed the records of 83 patients who underwent neoadjuvant chemoradiation for locally advanced, potentially resectable, and borderline resectable pancreatic cancers before definitive resection. We divided patients into three groups according to time interval between completion of chemoradiation and resection: group A (0–10 weeks), group B (11–20 weeks), and group C (>20 weeks). After chemoradiation, patients underwent ongoing chemotherapy before resection. Pathologic response was defined as major (>95 % fibrosis), partial (50–94 % fibrosis), or minor (<50 % fibrosis).


There were 56 patients in group A, 17 patients in group B, and 10 patients in group C. Patients in groups B and C were significantly more likely to experience a major response than group A (p < 0.013). Patients in group C had significantly increased median progression-free and overall survival (p < 0.05). Multivariable classification and regression tree analysis demonstrated pathologic response to be the only significant factor in overall survival.


Patients who underwent a prolonged time interval after neoadjuvant chemoradiation with ongoing chemotherapy were more likely to have an improved pathologic response at time of surgical resection, which was associated with improved median overall survival.


Overall Survival Gemcitabine Pathologic Response Additional Chemotherapy Pathologic Response Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors declare no conflict of interest.


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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Kathryn T. Chen
    • 1
  • Karthik Devarajan
    • 2
  • Barton N. Milestone
    • 3
  • Harry S. Cooper
    • 4
  • Crystal Denlinger
    • 5
  • Steven J. Cohen
    • 5
  • Joshua E. Meyer
    • 6
  • John P. Hoffman
    • 1
  1. 1.Department of Surgical OncologyFox Chase Cancer CenterPhiladelphiaUSA
  2. 2.Department of BiostatisticsFox Chase Cancer CenterPhiladelphiaUSA
  3. 3.Department of Diagnostic ImagingFox Chase Cancer CenterPhiladelphiaUSA
  4. 4.Department of PathologyFox Chase Cancer CenterPhiladelphiaUSA
  5. 5.Department of Medical OncologyFox Chase Cancer CenterPhiladelphiaUSA
  6. 6.Department of Radiation OncologyFox Chase Cancer CenterPhiladelphiaUSA

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