Neoadjuvant chemoradiotherapy versus upfront surgery for resectable and borderline resectable pancreatic cancer

The benefit of neoadjuvant chemoradiotherapy in resectable and borderline resectable pancreatic cancer over upfront surgery remains controversial, although many centers recommend neoadjuvant treatment on the basis of phase II and retrospective studies. The Dutch multicenter phase 3 PREOPANC trial found that among patients with resectable or borderline resectable pancreatic cancer, neoadjuvant chemoradiotherapy followed by surgery and adjuvant chemotherapy resulted in better long-term overall survival than upfront surgery and adjuvant chemotherapy (HR 0.73; p=0,025). In addition, the secondary outcomes disease-free survival, locoregional failure-free interval, and pathologic outcomes were significantly better after neoadjuvant treatment.