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J Gastrointest Oncol. 2018 Dec;9(6):982-988. doi: 10.21037/jgo.2018.04.03.

Chemoradiation after FOLFIRINOX for borderline resectable or locally advanced pancreatic cancer.

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Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Section of Medical Oncology, Yale University School of Medicine, New Haven, CT, USA.
Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
Department of Radiation Oncology, Hartford Hospital, Hartford, CT, USA.
Hematology/Oncology, Advocate Lutheran General Hospital, Park Ridge, IL, USA.
Department of Radiation Oncology, Torrance Memorial Medical Center, Torrance, CA, USA.
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.



The safety and efficacy of FOLFIRINOX (FX) followed by consolidative chemoradiation (CRT) in borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) has not been extensively studied. We sought to evaluate outcomes and toxicities of this regimen.


A retrospective review was performed of 33 patients with BRPC or LAPC treated with FX followed by CRT. Radiotherapy was directed at the primary tumor and any involved nodes (84.8% received 50-50.4 Gy with standard fractionation and concurrent capecitabine, while 15.2% of patients received 36 Gy in 15 fractions with weekly gemcitabine). Toxicities of FX and CRT were graded using Common Terminology Criteria for Adverse Events (CTCAE v4.0), and radiographic response was evaluated using Response Evaluation Criteria in Solid Tumors (RECIST). Overall survival (OS), distant metastasis-free survival (DMFS), and local control (LC) were calculated using Kaplan-Meier analyses, and a Cox proportional hazards model was used to assess the impact of clinicopathologic factors on OS.


Median follow-up was 19.9 months and patients received a median of 6.4 months of chemotherapy (range, 2.2-12.0 months). There were more T4 tumors than T3 tumors (70% vs. 30%). Grade ≥3 toxicities were low, including fatigue (9.1%), diarrhea (6.1%), neuropathy (6.1%), and dehydration (6.1%). R0 surgical resection was achieved in 5 patients (15.2%) after CRT. Median OS was 22.0 months (91% at 1 year and 45% at 2 years). Median DMFS was 17.8 months (69% at 1 year and 35% at 2 years). LC was 84% at 1 year and 55% at 2 years.


OS is promising with the use of FX in BRPC and LAPC, and consolidative CRT was well tolerated in this cohort. Therefore, the role of radiation after multi-agent chemotherapy should be further evaluated in prospective trials.


Pancreatic neoplasms; drug therapy; radiotherapy

Conflict of interest statement

Conflicts of Interest: This research was presented in part as a poster viewing presentation at the 55th Annual Meeting of the American Society for Radiation Oncology (ASTRO), September 22–25, 2013, Atlanta, GA.

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