Comparative survival outcomes of surgical resection versus radiotherapy after FOLFIRINOX in borderline resectable and locally advanced pancreatic cancer
- Author:
Jiwon YU
1
;
Jeong Ha LEE
;
Hyunju SHIN
;
Hee Chul PARK
;
Joon Oh PARK
;
Jung Yong HONG
;
Minsuk KWON
;
Ji Eun SHIN
;
Kyu Taek LEE
;
Kwang Hyuck LEE
;
Jong Kyun LEE
;
Joo Kyung PARK
;
Young Hoon CHOI
;
Jin Seok HEO
;
In Woong HAN
;
Sang Hyun SHIN
;
Hongbeom KIM
;
Ji Hye MIN
;
Jeong Il YU
Author Information
- Publication Type:Original Article
- From: Precision and Future Medicine 2026;10(1):39-50
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:This study evaluated the clinical outcomes and prognostic factors in patients with borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) treated with upfront FOLFIRINOX followed by local-regional therapy (LRT), surgical resection (SR), and radiotherapy (RT). We aimed to identify specific patient subgroups for which RT may serve as a reasonable alternative to SR for local tumor control.
Methods:We retrospectively analyzed 116 patients (SR group, n= 70; RT group, n= 46) at a single center between 2015 and 2020. Survival outcomes were compared based on LRT modalities, focusing on identifying subgroups in which RT provided an efficacy comparable to that of SR.
Results:Among 116 patients, the SR group achieved a significantly higher 5-year overall survival (OS) than the RT group (27.1% vs. 8.7%, P< 0.0001), despite similar progression-free survival (P= 0.23). Significant prognostic factors for OS included carbohydrate antigen 19-9 (CA19-9) response in BRPC (P= 0.02) and radiologic partial response in LAPC (P= 0.05). Subgroup analysis revealed that, while SR provided a survival advantage in CA19-9 responders, no significant difference in OS was observed between SR and RT in CA19-9 non-responders (P= 0.37).
Conclusion:Although surgery remains the gold standard, RT may be considered a justifiable local alternative for CA19-9 non-responders and surgically ineligible patients with LAPC, yielding comparable outcomes in these specific, biologically unfavorable subgroups.
