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

Huang, Xiaolun; Knoble, Jeanna; Zeng, Ming; Aguila, Fernando N; Patel, Tejas; Chambers, Lowell W.; Hu, Honglin; Líu, Hao

doi:10.1371/journal.pone.0166606

Cited by 10 publications

(7 citation statements)

References 19 publications

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“…NT in pancreatic cancer continues to be controversial. Its use in pancreatic cancer has previously demonstrated higher likelihood of achieving R0 margins in borderline resectable disease (18,(21)(22)(23)(24)(25). Achieving an R0 resection over R1 has demonstrated a significant improvement in median survival by 6 months (26).…”

Section: Discussionmentioning

confidence: 99%

Correlation of tumor size and survival in pancreatic cancer

Takahashi¹,

Shridhar²,

Huston³

et al. 2018

J. Gastrointest. Oncol.

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Background: Neoadjuvant therapy (NT) for resectable pancreatic adenocarcinoma (PAC) continues to be debated. We sought to establish the relationship between pancreatic tumor size, neoadjuvant chemotherapy (NCT), neoadjuvant chemoradiation (NCRT), and definitive surgery (DS) on survival.Methods: Utilizing the National Cancer Database we identified patients with PAC who underwent NT and DS. Patient characteristics and survival were compared with Mann-Whitney U, Pearson's Chi-square, and the Kaplan-Meier method. Multivariable analysis (MVA) was developed to identify predictors of survival. All tests were two-sided and α <0.05 was significant. Results: We identified 11,707 patients: 9,722 patients with tumors >2 cm and 1,985 with tumors ≤2 cm.There were 523 patients treated with NCT, 559 treated with NCRT, and 10,625 DS. Patients with tumors >2 cm were more likely to have higher T-stage, P<0.001, positive lymph nodes, P<0.001, poor histologic grade, P<0.001, and R1 resections, P<0.001. The median survival for patients with tumors ≤2 cm was 30.6 months compared to 20.5 months for those whose tumors were >2 cm, P<0.001. In the >2 cm groups the median survival for NCT, NCRT, and DS was 22.9, 25.8 and 21.3 months, P=0.01. MVA revealed that age, Charlson/Deyo score, N-stage, grade, tumor size >2 cm, R0 resection, and NT were predictors of survival. Ninety-day mortality was worse in both the NCT and NCRT compared to DS, P<0.001. Conclusions: The size of pancreatic cancer correlates to pathologic stage and overall survival. Tumors >2 and <2 cm benefited from a NT. However, the 90-operative mortality was significantly worse in those patients receiving NT.

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Section: Discussionmentioning

confidence: 99%

Correlation of tumor size and survival in pancreatic cancer

Takahashi¹,

Shridhar²,

Huston³

et al. 2018

J. Gastrointest. Oncol.

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“…[9][10][11][12][13][14] Several studies have compared postoperative complication rates for patients undergoing pancreaticoduodenectomy after neoadjuvant therapy and those undergoing primary pancreatic resection. 15,16 Teng et al 9 found that neoadjuvant chemoradiation therapy was associated with an increase in transfusion requirement and superficial SSI. However, the study did not find any associated 30-day mortality with the use of neoadjuvant chemoradiation therapy.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant Chemoradiation Therapy is Associated with Adverse Outcomes in Patients Undergoing Pancreaticoduodenectomy for Pancreatic Cancer

Aziz

Zeeshan

Jie

et al. 2019

The American Surgeon™

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The use of neoadjuvant chemoradiation therapy in patients with pancreatic adenocarcinoma is emerg-ing as an acceptable therapy option. The effects of neoadjuvant therapy on 30 days’ outcomes in patients with pancreatic cancer are not well defined in the literature. NSQIP (2009–2012) was used. Only patients with a diagnosis of pancreatic cancer and those who underwent a Whipple were included in the analysis. Patient who underwent neoadjuvant chemoradiation therapy were compared with those who did not receive therapy. Main outcome measures were as follows: complications, ≥2 units of blood transfusions, length of stay, readmission rates, return to the operating room, and 30-day mortality. A total of 1445 patients (395: neoadjuvant chemoradiation and 1050: no neoadjuvant therapy) were identified. The mean age was 67 ± 12 years, and 51 per cent of the patients were male. Neoadjuvant chemoradiation therapy was associated with increase in readmission rates (18% vs 12.2%, P 0.02), unanticipated return to the operating room (2.3% vs 1.1%, P 0.03) with no difference in mortality rates. Neoadjuvant chemoradiation therapy is associated with increase in inhospital complications. These differences in outcomes may be explained by the more advance stage of pancreatic cancer in these subsets of patients. Resource utilization and preoperative rehabilitation are of utmost significance to overcome this rise in complications associated with neoadjuvant chemoradiation therapy.

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“…Unlike CT and MRI, to date, the use of PET to adapt the radiotherapy plan on a daily basis has not been investigated. On the other hand, there are several papers reporting on the usefulness of PET imaging for the optimisation of target volume delineation [45][46][47][48][49][50][51] and the delivery of a radiotherapy boost 52,53 to improve the response outcome for patients with pancreatic cancer treated with radiotherapy (table 2).…”

Section: Pancreatic Cancermentioning

confidence: 99%