Three patients were alive with no evidence of disease (31, 33, 79 months), 2 alive with disease relapse (22, 21

months). Twenty-three patients were dead of disease (median 17 months, range, 4-75 months); two had died with no evidence of disease at 4 months (massive CVA) and 7 months (perforated viscous due to stent) and 1 had died with an uncertain status at 14 months. Table 2 Survival by prognostic factor Figure 1 Overall survival (OS) of (A) entire cohort Inhibitors,research,lifescience,medical (n=31) treated with neoadjuvant therapy; (B) by extent of resection. R0/R1 Gemcitabine buy resection (red, n=16) vs. R2 resection/Unresectable (blue, n=15) P=0.002 log-rank; (C) by pre-treatment extent of disease. Borderline … Resection status was the only significant predictor for survival (Table 2). When an R0 or R1 resection Inhibitors,research,lifescience,medical was achieved vs. R2 resection or unresectable disease, 2-year OS was 48% vs. 13% and 3-year OS was 36% vs. 0% (Figure 1B; P=0.002 log-rank). An OS advantage approached statistical significance for patients considered borderline resectable vs. unresectable in pre-treatment evaluation (Figure 1C; 2-year OS Inhibitors,research,lifescience,medical 63% vs. 15%, P=0.06 log rank). Other factors such as sex, site of the primary lesion, initial CA 19-9 level, change in CA 19-9 level with therapy, type of concurrent chemotherapy during EBRT, or maintenance chemotherapy (yes/no) were not prognostic for improved OS (Table 2). The DFS at 1 and 2 years was 64% and

20%, respectively, with a median of 13 months. No factors, including extent of surgical resection, predicted for improved DFS. Disease relapse Sites of relapse were evaluated in the total group of 31 patients (Table 3). LF/CF was documented in 5 of 31 patients (16%). The incidence of LF/CF in patients

who underwent Inhibitors,research,lifescience,medical resection (1/17; 6%) was lower compared to patients with unresectable disease (4/14; 29%), but this difference was not statistically significant. DM was documented in 24/31 patients (77%). Sites of metastatic failure included the liver (11 patients), peritoneum (10 patients), or lung/pleura/mediastinum (10 patients). Abdominal relapse in the liver or peritoneal cavity was documented in 22 of 31 patients (71%); the Inhibitors,research,lifescience,medical incidence did not differ by resection status, as noted in Table 3. Table 3 Patterns of relapse by resection status Treatment tolerance Preop CRT was generally well tolerated. The EBRT dose was attenuated to <45 Gy/25 Fx in 2/31 Carfilzomib patients (6%; Table 1) because of gastrointestinal intolerance (39.6 Gy/22 Fx; 43.2 Gy/24 Fx). Peri-operative morbidity and mortality also were analyzed. Grade 3 or 4 peri-operative morbidity was seen in 7/31 patients (23%). Re-operation was required in 4 patients [3 of 4 within 30 days: pancreatic leak/wound infection (1 patient), wound dehiscence (1 patient), wound dehiscence and small bowel obstruction (1 patient); 1 of 4 patients at post-operative day 49 with a gastro-jejunostomy leak]. An additional 3 patients required re-admission for ileus, dehydration or abscess within 30 days but were managed conservatively.