Borderline Resectable Pancreatic Cancer: What Have We Learned and Where Do We Go From Here?

Katz, Matthew H.; Pisters, Peter W.T.; Lee, Jeffrey E.; Fleming, Jason B.

doi:10.1245/s10434-010-1460-y

Cited by 35 publications

(19 citation statements)

References 11 publications

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“…In the up-front surgery strategy, several previous reports indicate a close association between the degree of PV involvement and prognosis, and PV involvement is used to determine the resectability status in many of the resectability definition systems, including the National Comprehensive Cancer Network definition. 6,7,[42][43][44] However, in our current study, the resectability status was associated only with the tumor-arterial relationship, regardless of the degree of PV involvement in cases in which a technical option for venous resection and reconstruction was available. Chun et al 8 reported detailed analyses regarding the association between the degree of PV involvement and the prognostic impact of preoperative CRT compared with the upfront surgery strategy.…”

Section: Discussioncontrasting

confidence: 55%

“…This observation indicates that the prognostic impact of the degree of PV involvement is minimized in preoperative CRT strategy. According to the definition system proposed by the MD Anderson Cancer Center group, a tumor exhibiting occlusion of the PV/SMV is defined as PC-BR if venous resection and reconstruction is technically possible, whereas the protocol of our current study defined a tumor exhibiting PV occlusion as PC-R. 7,43,45 However, there were no PC-R cases with PV occlusion in our current series. Given the anatomic proximity of the SMA to the PV/SMV system, the clinical significance of severe PV/SMV involvement (such as occlusion) in determining resectability status is affected by the concomitant arterial involvement.…”

Section: Discussionmentioning

confidence: 94%

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Preoperative Gemcitabine-Based Chemoradiation Therapy for Resectable and Borderline Resectable Pancreatic Cancer

Takahashi

Ohigashi²,

Gotoh³

et al. 2013

Annals of Surgery

137

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Objective: To evaluate the outcome of preoperative gemcitabine-based chemoradiation therapy (CRT) for resectable and borderline resectable pancreatic cancer (PC), with a focus on the differences in surgical outcomes and patterns of recurrence between these 2 categories. Background: Various multimodal treatment strategies have been proposed to improve the surgical outcomes of PC. Preoperative CRT and subsequent surgery is one of the promising strategies for resectable (PC-R) and borderline resectable (PC-BR) PC. Methods: A total of 268 patients with PC-R and PC-BR received preoperative gemcitabine-based CRT. The numbers of PC-R and PC-BR cases were 188 and 80, respectively. We evaluated the following comparisons between patients with PC-R and those with PC-BR: (1) resection rate, (2) rate of margin-negative resection, (3) survival, and (4) pattern of the treatment failure, including local recurrence, peritoneal dissemination, and distant metastasis. Results: The resection rate of patients with PC-R (87%) was higher than that of patients with PC-BR (54%) (P < 0.001). Pathological margin-negative resection was achieved in 99% and 98% of the patients with PC-R and PC-BR, respectively. The 5-year survival rates of the PC-R and PC-BR cases were 57% and 34%, respectively (P = 0.029). Although the 5-year cumulative incidence of local recurrence was comparable in both groups (15% and 13%, respectively; P = 0.508), the 5-year cumulative incidence of peritoneal and distant recurrence was significantly higher in the patients with PC-BR (43 and 76%) than in the patients with PC-R (17% and 43%). Conclusions: In the resected cases, the locoregional control was comparable between patients with PC-R and PC-BR after preoperative CRT. The survival rate for the patients with PC-BR was lower than the rate for those with PC-R due to a higher incidence of peritoneal and distant recurrence in the patients with PC-BR. (UMIN000001804)

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 94%

Preoperative Gemcitabine-Based Chemoradiation Therapy for Resectable and Borderline Resectable Pancreatic Cancer

Takahashi

Ohigashi²,

Gotoh³

et al. 2013

Annals of Surgery

137

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“…One patient with pancreatic pseudocyst developed local pain and radiographic enlargement and underwent surgery, which confirmed the pseudocyst rather than progressive disease. Since there is no clear evidence that a radiographic response to the neoadjuvant therapy for such a patient group is closely linked to the resectability, our results were consistent with previous reports [10]. …”

Section: Resultssupporting

confidence: 93%

Neoadjuvant Gemcitabine Chemotherapy followed by Concurrent IMRT Simultaneous Boost Achieves High R0 Resection in Borderline Resectable Pancreatic Cancer Patients

et al. 2016

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BackgroundTo study the feasibility of down stage the borderline resectable pancreatic cancer (BRPC) to resectable disease, we reported our institutional results using an intensity-modulated radiation therapy (IMRT) simultaneous integrated boost (SIB) dose escalation approach to improve R0 resectability.MethodsWe reviewed our past 7 years of experience of using neoadjuvant induction chemotherapy with Gemcitabine followed by concurrent chemoradiaiton for BRPC. During the concurrent, chemo was 5-FU and radiation were IMRT with SIB technique to target the key areas with dose escalation to 5600 in 28 fractions. The key areas were defined by PET positive area. This was followed by restaging imaging to rule out distant metastases before resection.Results25 finished dose escalation protocol. 2 of the 25 cases developed distant metastases, 23 (92%) patients without distant metastases underwent pancreatectomy. Among the those received pancreatectomy, 22 (95%) achieved negative margin (R0). The gastrointestinal toxicity > grade 2 was 8% and there was no grade 4 toxicity.ConclusionNeoadjuvant Gemcitabine-based induction chemotherapy followed by 5-FU-based IMRT-SIB is a feasible option in improving the likelihood of R0 resection rate in BRPC without compromising the organs at risk for toxicity.

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“…However, it is sometimes difficult to apply these definitions without any confusion in real clinical setting because some severity spectrum does exist even in borderline or locally advanced cancer, which might be one of the critical issues in making a homogenous study population in future clinical studies. 29 In summary, pancreatectomy following preoperative neoadjuvant CCRT in borderline resectable pancreatic cancer potentially enhances margin-negative resection to an extent similar to pancreatectomy without CCRT in initially resectable pancreatic cancer. Considering the significant pathological responsive rate, pancreatectomy following preoperative neoadjuvant CCRT therapy is thought to be able to enhance the quality of pancreatectomy in managing advanced pancreatic cancer.…”

Section: Discussionmentioning

confidence: 96%

“…A total dose of 45 or 50.4 Gy was applied with daily fractions of 1.8 Gy, 5 days per week, using a 10-MV linear accelerator. Patients received gemcitabine (1,000 mg/m [ 2 ] on days 1,8,15,29, and 36) with concurrent radiotherapy. Sometimes, cisplatin (70 mg/m [ 2 ] on days 1 and 29) was added according to the patients' general condition and medical oncologists' preference.…”

Section: Protocol For Preoperative Neoadjuvant Ccrtmentioning

confidence: 99%

Potential Contribution of Preoperative Neoadjuvant Concurrent Chemoradiation Therapy on Margin-Negative Resection in Borderline Resectable Pancreatic Cancer

Kang

Chung

Park

et al. 2012

Journal of Gastrointestinal Surgery

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Borderline Resectable Pancreatic Cancer: What Have We Learned and Where Do We Go From Here?

Cited by 35 publications

References 11 publications

Preoperative Gemcitabine-Based Chemoradiation Therapy for Resectable and Borderline Resectable Pancreatic Cancer

Preoperative Gemcitabine-Based Chemoradiation Therapy for Resectable and Borderline Resectable Pancreatic Cancer

Neoadjuvant Gemcitabine Chemotherapy followed by Concurrent IMRT Simultaneous Boost Achieves High R0 Resection in Borderline Resectable Pancreatic Cancer Patients

Potential Contribution of Preoperative Neoadjuvant Concurrent Chemoradiation Therapy on Margin-Negative Resection in Borderline Resectable Pancreatic Cancer

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