# ESPAC-5: immediate surgery versus short-course neoadjuvant chemotherapy or chemoradiotherapy in borderline resectable pancreatic cancer

Source: https://onco.cc/key-papers/paper-espac-5-neoadjuvant-borderline-resectable-ghaneh-lancet-gastroenterol-hepatol-2023/  
OnCo record `paper-espac-5-neoadjuvant-borderline-resectable-ghaneh-lancet-gastroenterol-hepatol-2023` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In borderline resectable pancreatic cancer, two months of chemotherapy before surgery did not change how many tumours could be removed but was followed by far better one-year survival than going straight to surgery.

## Summary

Four-arm randomised phase 2 feasibility trial at 16 sites: 90 patients with borderline resectable pancreatic cancer were randomised to immediate surgery (33), neoadjuvant gemcitabine plus capecitabine (20), FOLFIRINOX (20) or capecitabine-based chemoradiotherapy (17); 86 were analysed.

Resection rates were 68 percent after immediate surgery and 55 percent after neoadjuvant therapy (p 0.33), with R0 rates of 14 and 23 percent. One-year overall survival was 39 percent with immediate surgery against 78, 84 and 60 percent in the three neoadjuvant arms (p 0.0028); one-year disease-free survival from surgery was 33 against 59 percent (hazard ratio 0.53).

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Journal: The Lancet Gastroenterology and Hepatology
- Year: 2023
- DOI: 10.1016/S2468-1253(22)00348-X
- Authors: Ghaneh P, Palmer D, Cicconi S, et al.
- Findings: One-year overall survival 39 percent (95% CI 24 to 61) with immediate surgery versus 78 percent (gemcitabine plus capecitabine), 84 percent (FOLFIRINOX) and 60 percent (chemoradiotherapy); p 0.0028.; Resection 68 versus 55 percent (p 0.33); R0 resection 14 versus 23 percent (p 0.49).; One-year disease-free survival from surgery 33 versus 59 percent; hazard ratio 0.53 (0.28 to 0.98), p 0.016.
- What it means: Supports neoadjuvant therapy, preferably chemotherapy, for borderline resectable pancreatic cancer while larger trials define the regimen.
- Caveats: Feasibility design with small arms and a survival difference that was a secondary outcome.; Median follow-up only 12.2 months.

## Sources

- Lancet Gastroenterol Hepatol 2023: https://doi.org/10.1016/S2468-1253(22)00348-X
- PubMed: https://pubmed.ncbi.nlm.nih.gov/36521500/

## Connected records

- cancers: [Borderline resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/borderline-resectable-pdac/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- drugs: [Capecitabine](https://onco.cc/drugs/capecitabine/), [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/)
- trials: [ESPAC-5](https://onco.cc/trials/espac-5/)

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