Outcomes of Neoadjuvant Chemotherapy Versus Chemoradiation in Localized Pancreatic Cancer: A Case–Control Matched Analysis

Chopra, Abhishek; Hodges, Jacob C.; Olson, Adam C.; Burton, S.A.; Ellsworth, Susannah G.; Bahary, Nathan; Singhi, Aatur D.; Boone, Brian A.; Beane, Joal D.; Bartlett, David L.; Lee, Kenneth K.; Hogg, Melissa E.; Lotze, Michael T.; Paniccia, Alessandro; Zeh, Herbert J.; Zureikat, Amer H.

doi:10.1245/s10434-020-09391-9

Cited by 13 publications

(20 citation statements)

References 40 publications

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“…19 Some recent studies have demonstrated the potential benefit of SBRT in LAPC, both for local control and achieving R0 resection, 7,24,25 and combination therapy with potent chemotherapeutic agents would support the local control effect of radiation. [26][27][28] Conversely, the others showed addition of radiation was not helpful. 29,30 Because the protocol of dose and methods differs from study to study, further studies for the role of radiation are still needed in the future.…”

Section: F I G U R Ementioning

confidence: 99%

Impact of conversion surgery on survival in locally advanced pancreatic cancer patients treated with FOLFIRINOX chemotherapy

Lee

Kang

Kim

et al. 2021

J Hepato Biliary Pancreat

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Background: Locally advanced (unresectable) pancreatic cancer (LAPC) is surgically unresectable and often treated with chemotherapy. Most previous studies, that have evaluated conversion surgery after chemotherapy, included heterogeneous patients and chemotherapy regimens, making it challenging to determine the impact of FOLFIRINOX. The present study evaluated the survival benefit of conversion surgery in patients with LAPC who received FOLFIRINOX chemotherapy, and analyzed the prognostic factors. Methods: Patients with LAPC who received FOLFIRINOX as first-line therapy for at least four cycles were included. During chemotherapy, surgical eligibility was determined based on radiologic and metabolic response to the treatment. Clinicopathologic characteristics were compared between the curative-intent surgery and non-resection groups, and the prognostic factors were analyzed.Results: A total of 279 patients were included. The rates of partial response (PR) and stable disease (SD) were 34.1% and 51.4%, respectively, and 16.8% patients underwent curative-intent surgery. The median survival was significantly longer in the resection group than in the non-resection group (56 vs 21 months, P < .001). In a multivariate analysis, curative-intent surgery (HR 0.260; P < .001) was the most important factor. Conclusions: Conversion surgery after FOLFIRINOX chemotherapy effectivelyrescues patients with LAPC. Patients without progression after FOLFIRINOX could be considered as potential candidates for conversion surgery.

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Section: F I G U R Ementioning

confidence: 99%

Impact of conversion surgery on survival in locally advanced pancreatic cancer patients treated with FOLFIRINOX chemotherapy

Lee

Kang

Kim

et al. 2021

J Hepato Biliary Pancreat

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“…The results reported herein suggest a benefit for AT in the subset of patients with N0 disease who had PNI identified on final histopathology. Although historical data report a PNI rate of up to 92.0% for patients treated with a surgery-first approach, NART has been associated with reduced rates of PNI, LVI, and margin-positive resection and improved pathologic tumor response . However, such local antitumor effects have not translated into improved median survival when NART is compared with chemotherapy alone .…”

Section: Discussionmentioning

confidence: 99%

“…Although historical data report a PNI rate of up to 92.0% for patients treated with a surgery-first approach, NART has been associated with reduced rates of PNI, LVI, and margin-positive resection and improved pathologic tumor response . However, such local antitumor effects have not translated into improved median survival when NART is compared with chemotherapy alone . Recently reported results of the PREOPANC trial show a benefit in long-term (5-year) survival associated with NAT (including NART), which is likely due to improved local disease control …”

Section: Discussionmentioning

confidence: 99%

Evaluation of Adjuvant Chemotherapy Survival Outcomes Among Patients With Surgically Resected Pancreatic Carcinoma With Node-Negative Disease After Neoadjuvant Therapy

et al. 2023

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ImportanceNeoadjuvant therapy (NAT) is rarely associated with a complete histopathologic response in patients with pancreatic ductal adenocarcinoma (PDAC) but results in downstaging of regional nodal disease. Such nodal downstaging after NAT may have implications for the use of additional adjuvant therapy (AT).ObjectivesTo examine the prognostic implications of AT in patients with node-negative (N0) disease after NAT and to identify factors associated with progression-free (PFS) and overall survival (OS).Design, Setting, and ParticipantsA retrospective review was conducted using data from 2 high-volume, tertiary care academic centers (University of Pittsburgh Medical Center and the Medical College of Wisconsin). Prospectively maintained pancreatic cancer databases at both institutes were searched to identify patients with localized PDAC treated with preoperative therapy and subsequent surgical resection between 2010 and 2019, with N0 disease on final histopathology.ExposuresPatients received NAT consisting of chemotherapy with or without concomitant neoadjuvant radiation (NART). For patients who received NART, chemotherapy regimens were gemcitabine or 5-fluoururacil based and included stereotactic body radiotherapy (SBRT) or intensity-modulated radiation therapy (IMRT) after all intended chemotherapy and approximately 4 to 5 weeks before anticipated surgery. Adjuvant therapy consisted of gemcitabine-based therapy or FOLFIRINOX; when used, adjuvant radiation was commonly administered as either SBRT or IMRT.Main Outcomes and MeasuresThe association of AT with PFS and OS was evaluated in the overall cohort and in different subgroups. The interaction between AT and other clinicopathologic variables was examined on Cox proportional hazards regression analysis.ResultsIn this cohort study, 430 consecutive patients were treated between 2010 and 2019. Patients had a mean (SD) age of 65.2 (9.4) years, and 220 (51.2%) were women. The predominant NAT was gemcitabine based (196 patients [45.6%]), with a median duration of 2.7 cycles (IQR, 1.5-3.4). Neoadjuvant radiation was administered to 279 patients (64.9%). Pancreatoduodenectomy was performed in 310 patients (72.1%), and 160 (37.2%) required concomitant vascular resection. The median lymph node yield was 26 (IQR, 19-34); perineural invasion (PNI), lymphovascular invasion (LVI), and residual positive margins (R1) were found in 254 (59.3%), 92 (22.0%), and 87 (21.1%) patients, respectively. The restricted mean OS was 5.2 years (95% CI, 4.8-5.7). On adjusted analysis, PNI, LVI, and poorly differentiated tumors were independently associated with worse PFS and OS in N0 disease after NAT, with hazard ratios (95% CIs) of 2.04 (1.43-2.92; P &lt; .001) and 1.68 (1.14-2.48; P = .009), 1.47 (1.08-1.98; P = .01) and 1.54 (1.10-2.14; P = .01), and 1.90 (1.18-3.07; P = .008) and 1.98 (1.20-3.26; P = .008), respectively. Although AT was associated with prolonged survival in the overall cohort, the effect was reduced in patients who received NART and strengthened in patients with PNI (AT × PNI interaction: hazard ratio, 0.55 [95% CI, 0.32-0.97]; P = .04).Conclusions and RelevanceThe findings of this cohort study suggest a survival benefit for AT in patients with N0 disease after NAT and surgical resection. This survival benefit may be most pronounced in patients with PNI.

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“…Although a majority of studies reported pathological complete response (pCR), few studies highlighted other response evaluation criteria such as major pathological response (pMR) or near-complete response (nCR). 32,38,47,48 A pMR was defined as <5% residual viable cancer cells on post-neoadjuvant therapy (NAT) surgical specimen. 32 An nCR was defined by College of American Pathologists score as score 1 or single viable cells or small clusters of viable cells.…”

Section: Pathological Complete Response Ratementioning

confidence: 99%

“…Among these studies, 7, including the randomized controlled LAP 07 trial, showed no significant difference in median OS when CCRT was added following NACT. 11,27,31,36,39,40,47 The 2000-2001 FFCD/SFRO study, which compared induction CCRT versus IC with gemcitabine alone. Maintenance gemcitabine chemotherapy was given in both arms.…”

Section: Progression-free Survivalmentioning

confidence: 99%

Can Concurrent Chemoradiotherapy Add Meaningful Benefit in Addition to Induction Chemotherapy in the Management of Borderline Resectable and Locally Advanced Pancreatic Cancer?

Saha,

Wadsley,

Sirohi

et al. 2023

Pancreas

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ObjectivesThe role of concomitant chemoradiotherapy or radiotherapy (RT) after induction chemotherapy (IC) in borderline resectable and locally advanced pancreatic ductal adenocarcinoma is debatable. This systematic review aimed to explore this.MethodsWe searched PubMed, MEDLINE, EMBASE, and Cochrane database. Studies were selected reporting outcomes on resection rate, R0 resection, pathological response, radiological response, progression-free survival, overall survival, local control, morbidity, and mortality.ResultsThe search resulted in 6635 articles. After 2 rounds of screening, 34 publications were selected. We found 3 randomized controlled studies and 1 prospective cohort study, and the rest were retrospective studies. There is consistent evidence that addition of concomitant chemoradiotherapy or RT after IC improves pathological response and local control. There are conflicting results in terms of other outcomes.ConclusionsConcomitant chemoradiotherapy or RT after IC improves local control and pathological response in borderline resectable and locally advanced pancreatic ductal adenocarcinoma. The role of modern RT in improving other outcome requires further research.

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Outcomes of Neoadjuvant Chemotherapy Versus Chemoradiation in Localized Pancreatic Cancer: A Case–Control Matched Analysis

Cited by 13 publications

References 40 publications

Impact of conversion surgery on survival in locally advanced pancreatic cancer patients treated with FOLFIRINOX chemotherapy

Impact of conversion surgery on survival in locally advanced pancreatic cancer patients treated with FOLFIRINOX chemotherapy

Evaluation of Adjuvant Chemotherapy Survival Outcomes Among Patients With Surgically Resected Pancreatic Carcinoma With Node-Negative Disease After Neoadjuvant Therapy

Can Concurrent Chemoradiotherapy Add Meaningful Benefit in Addition to Induction Chemotherapy in the Management of Borderline Resectable and Locally Advanced Pancreatic Cancer?

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