{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T10:00:58Z","timestamp":1782208858049,"version":"3.54.5"},"reference-count":47,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,8,12]],"date-time":"2021-08-12T00:00:00Z","timestamp":1628726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomolecules"],"abstract":"<jats:p>In locally advanced pancreatic cancer (LAPC), the combination of chemotherapy and radiotherapy is a widely used treatment option. We performed a pooled analysis, including an exploratory analysis for prognostic and predictive factors, of two phase 2 trials including 73 patients with LAPC, treated with gemcitabine and oxaliplatin (GEMOX) and hypofractionated tomotherapy. With a median follow-up of 36 months (range 1\u201365), median progression-free (PFS) and overall survival (OS) were 10.2 (95% confidence interval [CI] 7.8\u201313.2) and 14.3 (95% CI 12.0\u201318.1) months, respectively. The overall resectability rate was 23.3% (95% CI 13.6\u201333.0), and the R0 resection rate was 13.7% (95% CI 5.8\u201321.6). In the multivariate analysis, ECOG performance status (PS) 0 and low levels of CA 19\u20139 were associated with improved OS and PFS. Concerning OS, log(CA19\u20139) resulted in a hazard ratio (HR) of 1.20 (95% CI 1.02\u20131.42), p = 0.027. For ECOG PS 0, HR was 1.00; for PS 1, HR was 2.69 (95% CI 1.46\u20134.96); for PS 2, HR was 4.18 (95% CI 0.90\u201319.46); p = 0.003. Low CA19\u20139 levels were also predictive for resection, with an odds ratio of 0.71 (95% CI 0.52\u20130.97), p = 0.034. In conclusion, GEMOX and hypofractionated radiotherapy is a treatment option in LAPC. Further studies are needed to identify differences in tumor biology, which may help to predict resectability and prognosis.<\/jats:p>","DOI":"10.3390\/biom11081200","type":"journal-article","created":{"date-parts":[[2021,8,12]],"date-time":"2021-08-12T22:14:36Z","timestamp":1628806476000},"page":"1200","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Multimodal Treatment with GEMOX Plus Helical Tomotherapy in Unresectable Locally Advanced Pancreatic Cancer: A Pooled Analysis of Two Phase 2 Studies"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7099-240X","authenticated-orcid":false,"given":"Alessandro","family":"Passardi","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori \u201cDino Amadori\u201d\u2014IRST, 47014 Meldola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1802-5671","authenticated-orcid":false,"given":"Ilario Giovanni","family":"Rapposelli","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori \u201cDino Amadori\u201d\u2014IRST, 47014 Meldola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7230-9267","authenticated-orcid":false,"given":"Emanuela","family":"Scarpi","sequence":"additional","affiliation":[{"name":"Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo Per lo Studio dei Tumori \u201cDino Amadori\u201d\u2014IRST, 47014 Meldola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Giulio","family":"Sullo","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori \u201cDino Amadori\u201d\u2014IRST, 47014 Meldola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Bartolini","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori \u201cDino Amadori\u201d\u2014IRST, 47014 Meldola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Neri","sequence":"additional","affiliation":[{"name":"Radiotherapy Unit, IRCCS Istituto Romagnolo Per lo Studio dei Tumori \u201cDino Amadori\u201d\u2014IRST, 47014 Meldola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Ghigi","sequence":"additional","affiliation":[{"name":"Radiotherapy Unit, IRCCS Istituto Romagnolo Per lo Studio dei Tumori \u201cDino Amadori\u201d\u2014IRST, 47014 Meldola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Tontini","sequence":"additional","affiliation":[{"name":"Radiotherapy Unit, IRCCS Istituto Romagnolo Per lo Studio dei Tumori \u201cDino Amadori\u201d\u2014IRST, 47014 Meldola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Ercolani","sequence":"additional","affiliation":[{"name":"General and Oncologic Surgery Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, 47121 Forl\u00ec, Italy"},{"name":"Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manlio","family":"Monti","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori \u201cDino Amadori\u201d\u2014IRST, 47014 Meldola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Ruscelli","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori \u201cDino Amadori\u201d\u2014IRST, 47014 Meldola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Matteucci","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori \u201cDino Amadori\u201d\u2014IRST, 47014 Meldola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Valgiusti","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori \u201cDino Amadori\u201d\u2014IRST, 47014 Meldola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni Luca","family":"Frassineti","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori \u201cDino Amadori\u201d\u2014IRST, 47014 Meldola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonino","family":"Romeo","sequence":"additional","affiliation":[{"name":"Radiotherapy Unit, IRCCS Istituto Romagnolo Per lo Studio dei Tumori \u201cDino Amadori\u201d\u2014IRST, 47014 Meldola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1001\/jamaoncol.2019.2996","article-title":"Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-Adjusted life-years for 29 cancer groups, 1990 to 2017: A systematic analysis for the global burden of disease study","volume":"5","author":"Fitzmaurice","year":"2019","journal-title":"JAMA Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21654","article-title":"Cancer Statistics, 2021","volume":"71","author":"Siegel","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1148\/radiol.13131184","article-title":"Pancreatic Ductal Adenocarcinoma Radiology Reporting Template: Consensus Statement of the Society of Abdominal Radiology and the American Pancreatic Association","volume":"270","author":"Francis","year":"2014","journal-title":"Radiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/S1470-2045(16)00172-8","article-title":"FOLFIRINOX for locally advanced pancreatic cancer: A systematic review and patient-level meta-analysis","volume":"17","author":"Suker","year":"2016","journal-title":"Lancet Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.ejca.2021.02.023","article-title":"Nab-paclitaxel\/gemcitabine combination is more effective than gemcitabine alone in locally advanced, unresectable pancreatic cancer\u2014A GISCAD phase II randomized trial","volume":"148","author":"Cascinu","year":"2021","journal-title":"Eur. J. Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.ejca.2018.07.007","article-title":"A randomised phase 2 trial of nab-paclitaxel plus gemcitabine with or without capecitabine and cisplatin in locally advanced or borderline resectable pancreatic adenocarcinoma","volume":"102","author":"Reni","year":"2018","journal-title":"Eur. J. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1002\/1097-0142(19811015)48:8<1705::AID-CNCR2820480803>3.0.CO;2-4","article-title":"Therapy of locally unresectable pancreatic carcinoma: A randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil. The gastrointestinal tumor study group","volume":"48","author":"Moertel","year":"1981","journal-title":"Cancer"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1093\/annonc\/mdn281","article-title":"Phase III trial comparing intensive induction chemoradiotherapy (60 Gy, infusional 5-FU and intermittent cisplatin) followed by maintenance gemcitabine with gemcitabine alone for locally advanced unresectable pancreatic cancer. Definitive results of the 2000\u201301 FFCD\/SFRO study","volume":"19","author":"Chauffert","year":"2008","journal-title":"Ann. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4105","DOI":"10.1200\/JCO.2011.34.8904","article-title":"Gemcitabine Alone Versus Gemcitabine Plus Radiotherapy in Patients With Locally Advanced Pancreatic Cancer: An Eastern Cooperative Oncology Group Trial","volume":"29","author":"Sr","year":"2011","journal-title":"J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1200\/JCO.2006.07.5663","article-title":"Impact of Chemoradiotherapy After Disease Control With Chemotherapy in Locally Advanced Pancreatic Adenocarcinoma in GERCOR Phase II and III Studies","volume":"25","author":"Huguet","year":"2007","journal-title":"J. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1002\/cncr.22735","article-title":"Induction chemotherapy selects patients with locally advanced, unresectable pancreatic cancer for optimal benefit from consolidative chemoradiation therapy","volume":"110","author":"Krishnan","year":"2007","journal-title":"Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.1001\/jama.2016.4324","article-title":"Effect of chemoradiotherapy vs. chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib the LAP07 randomized clinical trial","volume":"315","author":"Hammel","year":"2016","journal-title":"JAMA J. Am. Med. Assoc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1002\/cncr.24059","article-title":"Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas","volume":"115","author":"Chang","year":"2009","journal-title":"Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/j.ijrobp.2013.02.022","article-title":"Stereotactic Body Radiation Therapy for Locally Advanced and Borderline Resectable Pancreatic Cancer Is Effective and Well Tolerated","volume":"86","author":"Chuong","year":"2013","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1177\/1533034616650778","article-title":"Can Stereotactic Body Radiation Therapy Be a Viable and Efficient Therapeutic Option for Unresectable Locally Advanced Pancreatic Adenocarcinoma? Results of a Phase 2 Study","volume":"16","author":"Comito","year":"2017","journal-title":"Technol. Cancer Res. Treat."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1097\/COC.0000000000000118","article-title":"Stereotactic Body Radiation Therapy (SBRT) Combined With Chemotherapy for Unresected Pancreatic Adenocarcinoma","volume":"40","author":"Gurka","year":"2017","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e615","DOI":"10.1016\/j.ijrobp.2011.04.045","article-title":"Induction Gemcitabine and Stereotactic Body Radiotherapy for Locally Advanced Nonmetastatic Pancreas Cancer","volume":"81","author":"Mahadevan","year":"2011","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"979","DOI":"10.3109\/0284186X.2015.1004367","article-title":"Long-term outcomes of induction chemotherapy and neoadjuvant stereotactic body radiotherapy for borderline resectable and locally advanced pancreatic adenocarcinoma","volume":"54","author":"Mellon","year":"2015","journal-title":"Acta Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13014-018-1063-5","article-title":"Clinical evaluation of intensity-modulated radiotherapy for locally advanced pancreatic cancer","volume":"13","author":"Goto","year":"2018","journal-title":"Radiat. Oncol."},{"key":"ref_20","first-page":"599","article-title":"GEMOX plus tomotherapy for unresectable locally advanced pancreatic cancer","volume":"58","author":"Milandri","year":"2011","journal-title":"Hepatogastroenterology"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Passardi, A., Scarpi, E., Neri, E., Parisi, E., Ghigi, G., Ercolani, G., Gardini, A., La Barba, G., Pagan, F., and Valgiusti, M. (2019). Chemoradiotherapy (Gemox Plus Helical Tomotherapy) for Unresectable Locally Advanced Pancreatic Cancer: A Phase II Study. Cancers, 11.","DOI":"10.3390\/cancers11050663"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2269","DOI":"10.1200\/JCO.2008.19.7921","article-title":"Chemoradiotherapy in the Management of Locally Advanced Pancreatic Carcinoma: A Qualitative Systematic Review","volume":"27","author":"Huguet","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2786","DOI":"10.1093\/annonc\/mdx495","article-title":"Selecting patients for resection after primary chemotherapy for non-metastatic pancreatic adenocarcinoma","volume":"28","author":"Reni","year":"2017","journal-title":"Ann. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1177\/1758835920953294","article-title":"FOLFIRINOX in borderline resectable and locally advanced unresectable pancreatic adenocarcinoma","volume":"12","author":"Yoo","year":"2020","journal-title":"Ther. Adv. Med. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.radonc.2020.11.006","article-title":"A phase II study of stereotactic radiotherapy after FOLFIRINOX for locally advanced pancreatic cancer (LAPC-1 trial): Long-term outcome","volume":"155","author":"Teriaca","year":"2021","journal-title":"Radiother. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.adro.2018.07.002","article-title":"Improving prediction of surgical resectability over current staging guidelines in patients with pancreatic cancer who receive stereotactic body radiation therapy","volume":"3","author":"Cheng","year":"2018","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"31999","DOI":"10.18632\/oncotarget.25877","article-title":"Intensification of induction chemotherapy before consolidation chemoradiotherapy improves progression-free survival and time without treatment in patients with locally advanced pancreatic cancers","volume":"9","author":"Williet","year":"2018","journal-title":"Oncotarget"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2913","DOI":"10.1002\/cam4.1553","article-title":"Prospective analysis of different combined regimens of stereotactic body radiation therapy and chemotherapy for locally advanced pancreatic cancer","volume":"7","author":"Zhu","year":"2018","journal-title":"Cancer Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1002\/cncr.27736","article-title":"Induction gemcitabine and oxaliplatin therapy followed by a twice-weekly infusion of gemcitabine and concurrent external-beam radiation for neoadjuvant treatment of locally advanced pancreatic cancer: A single institutional experience","volume":"119","author":"Leone","year":"2013","journal-title":"Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1200\/JCO.2007.12.8223","article-title":"Concomitant administration of weekly oxaliplatin, fluorouracil continuous infusion, and radiotherapy after 2 months of gemcitabine and oxaliplatin induction in patients with locally advanced pancreatic cancer: A Groupe Coordinateur Multidisciplinaire en Oncologie phase II study","volume":"26","author":"Afchain","year":"2008","journal-title":"J. Clin. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"7879","DOI":"10.1002\/cam4.3330","article-title":"Stereotactic body radiotherapy vs. conventionally fractionated chemoradiation in locally advanced pancreatic cancer: A multicenter case-control study (PAULA-1)","volume":"9","author":"Arcelli","year":"2020","journal-title":"Cancer Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3486","DOI":"10.1002\/cncr.30706","article-title":"Outcomes for patients with locally advanced pancreatic adenocarcinoma treated with stereotactic body radiation therapy versus conventionally fractionated radiation","volume":"123","author":"Zhong","year":"2017","journal-title":"Cancer"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2120","DOI":"10.1002\/cncr.32756","article-title":"Conventionally fractionated radiation therapy versus stereotactic body radiation therapy for locally advanced pancreatic cancer (CRiSP): An international systematic review and meta-analysis","volume":"126","author":"Tchelebi","year":"2020","journal-title":"Cancer"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"496","DOI":"10.21037\/jgo-21-160","article-title":"Dosimetric feasibility on hypofractionated intensity-modulated radiotherapy and simultaneous integrated boost for locally advanced unresectable pancreatic cancer with helical tomotherapy","volume":"12","author":"Teng","year":"2021","journal-title":"J. Gastrointest. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.ijrobp.2020.11.017","article-title":"Maximizing Tumor Control and Limiting Complications With Stereotactic Body Radiation Therapy for Pancreatic Cancer","volume":"110","author":"Mahadevan","year":"2021","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"100200","DOI":"10.1016\/j.eclinm.2019.10.013","article-title":"Efficacy and feasibility of stereotactic radiotherapy after folfirinox in patients with locally advanced pancreatic cancer (LAPC-1 trial)","volume":"17","author":"Suker","year":"2019","journal-title":"EClinicalMedicine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/j.ijrobp.2013.12.030","article-title":"Phase 2 trial of induction gemcitabine, oxaliplatin, and cetuximab followed by selective capecitabine-based chemoradiation in patients with borderline resectable or unresectable locally advanced pancreatic cancer","volume":"88","author":"Esnaola","year":"2014","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Wijetunga, A.R., Chua, T.C., Nahm, C.B., Pavlakis, N., Clarke, S., Chan, D.L., Diakos, C., Maloney, S., Ashrafi-Zadeh, A., and Kneebone, A. (2021). Survival in borderline resectable and locally advanced pancreatic cancer is determined by the duration and response of neoadjuvant therapy. Eur. J. Surg. Oncol.","DOI":"10.1016\/j.ejso.2021.04.005"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1007\/s00261-020-02661-w","article-title":"Prognostic factors in patients with locally advanced or borderline resectable pancreatic ductal adenocarcinoma: Chemotherapy vs. chemoradiotherapy","volume":"46","author":"Kim","year":"2021","journal-title":"Abdom. Radiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1002\/jso.26567","article-title":"Predicting overall survival and resection in patients with locally advanced pancreatic cancer treated with FOLFIRINOX: Development and internal validation of two nomograms","volume":"124","author":"Brada","year":"2021","journal-title":"J. Surg. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1007\/s00432-019-03066-z","article-title":"Clinical outcomes and prognostic factors of stereotactic body radiation therapy combined with gemcitabine plus capecitabine for locally advanced unresectable pancreatic cancer","volume":"146","author":"Shen","year":"2020","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.radonc.2013.05.011","article-title":"Dosimetric and clinical predictors of toxicity following combined chemotherapy and moderately hypofractionated rotational radiotherapy of locally advanced pancreatic adenocarcinoma","volume":"108","author":"Cattaneo","year":"2013","journal-title":"Radiother. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/COC.0000000000000263","article-title":"Albumin and Neutrophil-Lymphocyte Ratio (NLR) Predict Survival in Patients With Pancreatic Adenocarcinoma Treated With SBRT","volume":"41","author":"Alagappan","year":"2018","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Allen, J., Cernik, C., Bajwa, S., Al-Rajabi, R., Saeed, A., Baranda, J., Williamson, S., Sun, W., and Kasi, A. (2020). Association of Neutrophil, Platelet, and Lymphocyte Ratios with the Prognosis in Unresectable and Metastatic Pancreatic Cancer. J. Clin. Med., 9.","DOI":"10.3390\/jcm9103283"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Ren, H., Zhang, J.-W., Lan, Z.-M., Du, Y.-X., Qiu, G.-T., Zhang, L.-P., Gu, Z.-T., Li, Z.-Z., Li, G., and Shao, H.-B. (2021). Intraoperative radiotherapy vs. concurrent chemoradiotherapy in the treatment of patients with locally advanced pancreatic cancer. Pancreatology.","DOI":"10.1016\/j.pan.2021.04.007"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Khomiak, A., Brunner, M., Kordes, M., Lindblad, S., Miksch, R.C., \u00d6hlund, D., and Regel, I. (2020). Recent Discoveries of Diagnostic, Prognostic and Predictive Biomarkers for Pancreatic Cancer. Cancers, 12.","DOI":"10.3390\/cancers12113234"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Cozzi, L., Comito, T., Fogliata, A., Franzese, C., Franceschini, D., Bonifacio, C., Tozzi, A., Di Brina, L., Clerici, E., and Tomatis, S. (2019). Computed tomography based radiomic signature as predictive of survival and local control after stereotactic body radiation therapy in pancreatic carcinoma. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0210758"}],"container-title":["Biomolecules"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2218-273X\/11\/8\/1200\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:45:06Z","timestamp":1760165106000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2218-273X\/11\/8\/1200"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,12]]},"references-count":47,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["biom11081200"],"URL":"https:\/\/doi.org\/10.3390\/biom11081200","relation":{},"ISSN":["2218-273X"],"issn-type":[{"value":"2218-273X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,12]]}}}