Neoadjuvant therapy versus upfront surgery for borderline-resectable pancreatic cancer

Han, Sang-In; Choi, Seong Ho; Choi, Dong Wook; Heo, Jin Seok; Han, In Woong; Park, Dae-Joon; Ryu, Yoshinori

doi:10.23736/s0026-4733.19.07958-6

Cited by 6 publications

(4 citation statements)

References 41 publications

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“…However, the evidence level remains too low for a firm conclusion [11] . In a recent study from Korea the overall 2-year survival rate was 51.1% in the upfront surgery group and 36.7% in the neoadjuvant group [12] . However in patients who could undergo surgery after neoadjuvant therapy the survival was comparable.…”

Section: Discussionmentioning

confidence: 94%

Upfront surgery in borderline resectable pancreatic cancer

Thumma¹,

Gunturi²,

K³

et al. 2019

Int. J. Surg. Sci.

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Introduction: The definition of Borderline resectable pancreatic cancer (BRPC) is evolving. In general BRPC is considered when high rate of margin positivity is possible without neoadjuvant therapy. Though neoadjuvant therapy is emerging in BPRC there is still role of upfront surgery in some patients with BRPC. Aim: The aim of the present study was to study the surgical feasibility and perioperative outcomes in patients with BRPC undergoing upfront surgery. Material and methods:The study was done from data collected from prospectively maintained database between 2013 to 2018. Patients with pancreatic and periampullary tumors who were classified BRPC according to NCCN 2018 classification. In addition solid tumor contact of tumors to PV/SMV of less than 180 degrees were also included as BRPC. Tumors with abutment of PV and SMV with thrombosis or obliteration of lumen were excluded. The surgical feasibility, complication and R0 resection rate was studied. Results: A total of 22 patients were included in the study. Eleven (11/22, 50%) patients underwent vascular resection. In 5 (5/22, 22.7%) patients pancreaticoduodenectomy could be done without the need for vascular resection. In 6 (6/22, 27%) patients palliative therapy was done due to metastatic disease (2) or locally advanced disease (4).Of the 11 patients who underwent vascular resections Grade A pancreatic fistula was seen in 3 (3/11), Grade B pancreatic fistula 1(1/11) Delayed gastric emptying in 3 (3/11) and wound infection in 2 (2/11) There was no mortality. The resection margin was positive in 3 patients (3/16, 18%). Conclusion: Upfront vascular resection is possible in carefully selected patients with good resectability and R0 resection rates.

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Section: Discussionmentioning

confidence: 94%

Upfront surgery in borderline resectable pancreatic cancer

Thumma¹,

Gunturi²,

K³

et al. 2019

Int. J. Surg. Sci.

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“…16 , 17 In addition, compared with intravenous administration, oral administration of capecitabine is associated with various advantages such as reduced pain in patients. 18 …”

Section: Discussionmentioning

confidence: 99%

Clinical effects of neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy on complications and recurrence in patients with advanced gastric cancer

Wang,

Li,

Zheng

et al. 2024

Pak J Med Sci

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Objective: To compare the clinical effects of neoadjuvant chemoradiotherapy (NCRT) and neoadjuvant chemotherapy (NCT) on complications and recurrence in patients with advanced gastric cancer (AGC). Method: This was a retrospective study. A total of 83 patients with AGC admitted to Chengde Central Hospital between Jan. 2019 and Jun. 2021 were selected and divided into the observation group(n=41) and the control group(n=42) using a random number table. Patients in the control group received XELOX chemotherapy, and those in the observation group received intensity-modulated radiotherapy (IMRT) with concurrent XELOX chemotherapy. Compared efficacy, pathological complete response rate (pCR), R0 resection rate, adverse reactions, and quality of life (QOL) before and after treatment between the two groups. Results: The efficacy, pCR, and R0 resection rate of the observation group were significantly increased compared with those of the control group. Comparison of complications showed the number of patients experiencing gastrointestinal (GI) reactions, increased BUN, increased GPT, alopecia, and pigmentation in the observation group was decreased compared with that in the control group, with no statistically significant differences(p>0.05), and the number of patients experiencing myelosuppression was statistically significant between the two groups(p<0.05). There were no significant differences in sub-scores of physical, role, emotional, cognitive, and social functions and the overall score of QOL between the two groups(p>0.05) before treatment. Conclusion: NCRT is safer and more effective in patients with AGC compared with NCT, and can significantly improve the QOL of patients. It can be widely used in clinical practice. doi: https://doi.org/10.12669/pjms.40.7.9052 How to cite this: Wang R, Li M, Zheng Y, Zhang W, Song J, Yang F. Clinical effects of neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy on complications and recurrence in patients with advanced gastric cancer. Pak J Med Sci. 2024;40(7):---------. doi: https://doi.org/10.12669/pjms.40.7.9052 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…Clinical trials support the standard role of adjuvant chemotherapy though routine use of adjuvant radiation therapy remains controversial (3)(4)(5)(7)(8)(9)(10)(11)(12)(13). Several recent clinical trials show that neoadjuvant chemotherapy followed by chemoradiation may improve the rates of R0 resection, lymph node sterilization, local control, and possibly overall survival (OS) compared to upfront resection, with benefits likely being greatest for patients with borderline resectable pancreas cancer (6,(14)(15)(16). The phase III randomized PREOPANC study suggested that preoperative chemoradiotherapy may lead to tumor downstaging and a reduction in the rates of adverse pathologic features (16).…”

Section: Introductionmentioning

confidence: 99%

Predicting Adverse Pathologic Features and Clinical Outcomes of Resectable Pancreas Cancer With Preoperative CA 19-9

et al. 2021

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BackgroundWe evaluated preoperative CA 19-9 levels in patients with resected pancreatic cancer to analyze whether they were predictive of clinical outcomes and could help select patients for additional therapy. We hypothesized that elevated CA 19-9 would be associated with worse pathologic findings and oncologic outcomes.MethodsThis study assessed 509 patients with non-metastatic pancreatic adenocarcinoma who underwent resection at our institution from 1995-2011 and had preoperative CA 19-9 recorded. No patients received neoadjuvant therapy. CA 19-9 level was analyzed as a continuous and a dichotomized (> vs. ≤ 55 U/mL) variable using logistic and Cox models.ResultsMedian follow-up was 7.8 years, and the median age was 66 years (33-90). 64% of patients had elevated preoperative CA 19-9 (median: 141 U/mL), that did not correlate with bilirubin level or tumor size. Most patients had ≥ T3 tumors (72%) and positive lymph nodes (62%). The rate of incomplete (R1 or R2) resection was 19%. Increasing preoperative CA 19-9 was associated with extra-pancreatic extension (p=0.0005), lymphovascular space invasion (p=0.0072), incomplete resection [HR (95% CI) 2.0 (1.2-3.5)], and lower OS [HR = 1.6 (1.3-2.0)]. Each doubling in preoperative CA 19-9 value was associated with an 8.3% increased risk of death [HR = 1.08 (1.02-1.15)] and a 10.0% increased risk of distant recurrence [HR = 1.10 (1.02-1.19)]. Patients classified as non-secretors had comparable outcomes to patients with normal CA 19-9.ConclusionsElevated preoperative CA 19-9 level was associated with adverse pathologic features, incomplete resection, and inferior clinical outcomes. Neither tumor size nor bilirubin confound an elevated CA 19-9 level. Preoperative CA 19-9 level may help select patients for additional therapy.

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Neoadjuvant therapy versus upfront surgery for borderline-resectable pancreatic cancer

Cited by 6 publications

References 41 publications

Upfront surgery in borderline resectable pancreatic cancer

Upfront surgery in borderline resectable pancreatic cancer

Clinical effects of neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy on complications and recurrence in patients with advanced gastric cancer

Predicting Adverse Pathologic Features and Clinical Outcomes of Resectable Pancreas Cancer With Preoperative CA 19-9

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