Preoperative Gemcitabine/Nab‐Paclitaxel With Concurrent Radiation Therapy for Borderline Resectable Pancreatic Cancer: A Comparative Analysis With Preoperative Chemoradiation Therapy Using Gemcitabine Alone

ABSTRACT Background Although NCCN guidelines recommend preoperative therapy for borderline resectable pancreatic cancer (BR‐PC), it is still unclear which regimen is better. The study objective was to elucidate the prognostic significance of neoadjuvant chemoradiotherapy (NACRT) with gemcitabine/nab‐paclitaxel (GnP‐RT) compared to gemcitabine alone (Gem‐RT) in BR‐PC. Methods Of 201 patients with BR‐PC enrolled in the study, 102 were receiving GnP‐RT and 99 were receiving Gem‐RT. We evaluated clinical outcomes between these two groups, including CA19‐9 values, rate of tumor reduction, overall (OS) and progression‐free survival (PFS) rates, and distant and local recurrence. Results CA19‐9 values and tumor size reduction rate after NACRT were significantly higher with GnP‐RT than with Gem‐RT. With GnP‐RT, the 5‐year OS rate was 55.2% and the PFS rate was 42.1%, both significantly better than rates with Gem‐RT (OS, 35.4%, p = 0.006; PFS, 31.9%, p = 0.041). The incidence of distant recurrence with GnP‐RT was significantly lower than with Gem‐RT ( p = 0.018), but the incidence of local recurrence did not differ between the two groups ( p = 0.905), indicating that the better survival with GnP‐RT might arise from a systemic effect of enhanced chemotherapy. Conclusion Enhanced chemotherapy may improve survival in patients with BR‐PC by suppressing distant metastasis through a potent systemic antitumor effect.