# Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial

Source: https://onco.cc/key-papers/paper-preopanc-preoperative-chemoradiotherapy-jco-2020/  
OnCo record `paper-preopanc-preoperative-chemoradiotherapy-jco-2020` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The 2020 primary report of the Dutch PREOPANC trial: giving chemotherapy and radiotherapy before surgery did not significantly lengthen survival overall, but it raised clear-margin resections from 40 to 71 percent and helped the patients whose tumours were borderline operable.

## Summary

PREOPANC randomised 246 patients with resectable or borderline resectable pancreatic cancer at 16 Dutch centres between April 2013 and July 2017 to preoperative chemoradiotherapy (three courses of gemcitabine, the second with 15 fractions of 2.4 Gy, then surgery and four courses of adjuvant gemcitabine; 119 patients) or immediate surgery followed by six courses of adjuvant gemcitabine (127). Median overall survival by intention to treat was 16.0 versus 14.3 months (hazard ratio 0.78, 95 percent confidence interval 0.58 to 1.05, P = 0.096). The resection rate was 61 versus 72 percent; the R0 rate 71 percent (51 of 72) versus 40 percent (37 of 92), P less than 0.001. Preoperative treatment was associated with better disease-free survival and locoregional failure-free interval and fewer positive nodes, perineural and venous invasion; serious adverse events occurred in 52 versus 41 percent. The long-term analysis (2022, recorded separately) showed a survival benefit at five years.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: pancreatic-evidence
- Journal: Journal of Clinical Oncology
- Year: 2020
- DOI: 10.1200/JCO.19.02274
- Authors: Versteijne E, Suker M, Groothuis K, et al.
- Findings: 246 patients; preoperative gemcitabine-based chemoradiotherapy versus immediate surgery.; Median overall survival 16.0 versus 14.3 months (hazard ratio 0.78, P = 0.096), not significant at the primary analysis.; R0 resection 71 versus 40 percent; resection rate 61 versus 72 percent.; Serious adverse events 52 versus 41 percent.
- What it means: The trial that made neoadjuvant treatment standard for borderline resectable disease and opened the still unresolved question for resectable disease, which PREOPANC-2, NORPACT-1, PREOPANC-3 and Alliance A021806 inherited.
- Caveats: Gemcitabine alone is no longer the chemotherapy standard; the trial's regimens were superseded before it reported.; The primary endpoint was not met; the practice change rests on secondary endpoints and the long-term update.

## Sources

- J Clin Oncol 2020: https://doi.org/10.1200/JCO.19.02274
- PubMed: https://pubmed.ncbi.nlm.nih.gov/32105518/
- Netherlands Trial Register NTR3709: https://www.onderzoekmetmensen.nl/en/trial/24580

## Connected records

- key papers: [Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial](https://onco.cc/key-papers/paper-preopanc-2-neoadjuvant-folfirinox-vs-chemoradiotherapy-lancet-oncol-2025/), [PREOPANC long-term results: neoadjuvant gemcitabine-based chemoradiotherapy versus upfront surgery for resectable and borderline resectable pancreatic cancer](https://onco.cc/key-papers/paper-preopanc-neoadjuvant-chemoradiotherapy-long-term-jco-2022/), [Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial](https://onco.cc/key-papers/paper-versteijne-j-clin-oncol/)
- cancers: [Borderline resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/borderline-resectable-pdac/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/resectable-pdac/)
- fronts: [Radiation Therapy](https://onco.cc/fronts/radiation/), [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/)
- drugs: [Gemcitabine](https://onco.cc/drugs/gemcitabine/)
- institutions: [Amsterdam UMC / Cancer Center Amsterdam](https://onco.cc/institutions/amsterdam-umc/), [Erasmus MC Cancer Institute](https://onco.cc/institutions/erasmus-mc/)
- terms: [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Resectable, borderline resectable and unresectable](https://onco.cc/terms/resectability/), [Resection margins (R0 / R1 / R2)](https://onco.cc/terms/resection-margins/)
- trials: [PREOPANC-1](https://onco.cc/trials/preopanc/)
- people: [Marc G. Besselink](https://onco.cc/people/marc-besselink/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)
- roadmaps: [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)
- ideas: [Chemotherapy before surgery for every resectable pancreatic cancer, settled by the two perioperative trials rather than assumed](https://onco.cc/ideas/idea-pdac-neoadjuvant-chemotherapy-for-all-resectable-disease/)

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