Significance of Histological Response to Preoperative Chemoradiotherapy for Pancreatic Cancer

White, Rebekah R.; Xie, H. Bill; Gottfried, Marcia R.; Czito, Brian G.; Hurwitz, Herbert I.; Morse, Michael A.; Blobe, Gerard C.; Paulson, Erik K.; Baillie, John; Branch, M. Stanley; Jowell, Paul S.; Clary, Bryan M.; Pappas, Theodore N.; Tyler, Douglas S.

doi:10.1245/aso.2005.03.105

Cited by 148 publications

(118 citation statements)

References 20 publications

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“…Several variables of tumor response to neoadjuvant therapy have been proposed, including the number of severe degenerative cancer cells (SDCC), percentage of viable cells, degree of fibrosis or presence of necrosis (69,70). In a trial using SDCC to evaluate response to preoperative therapy, no advantage in terms of OS was observed in 13/26 patients who achieved a major response, defined as >80% SDCC (66).…”

Section: Discussionmentioning

confidence: 99%

“…In total, two trials correlated survival with the degree of fibrosis following neoadjuvant therapy, with conflicting results (71,72). However, when the presence of tumor necrosis and fibrosis were analyzed, only tumor necrosis was observed to be an adverse prognostic factor (70). The College of American Pathologists has proposed a grading system for tumor response subsequent to neoadjuvant therapy: 0) Complete response, no viable cells; i) moderate response, single or small groups of cells; ii) minimal response, residual cancer outgrown by fibrosis; and iii) poor response, extensive residual cancer (67).…”

Section: Discussionmentioning

confidence: 99%

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Neoadjuvant chemotherapy in borderline resectable pancreatic cancer: A case report

2017

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Abstract. Pancreatic cancer is the fourth leading cause of cancer mortality and is associated with a poor overall survival even when diagnosed early and considered resectable. Complete surgical removal with negative histological margins is an independent predictor of survival and remains the only potential curative treatment. In borderline resectable pancreatic adenocarcinoma (BRPAC), preoperative systemic therapy may increase resectability and margin-negative resection rate. There is no current consensus on the optimal chemotherapy regimen for BRPAC. The present case describes a patient with BRPAC who achieved a pathological complete response to neoadjuvant FOLFIRINOX (folinic acid, fluorouracil, irinotecan and oxaliplatin), but early relapse following a pancreaticoduodenectomy without vascular resection, with an uneventful postoperative course, except for a pulmonary embolism.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neoadjuvant chemotherapy in borderline resectable pancreatic cancer: A case report

2017

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“…An alternative interpretation and one that we ascribe to is that neoadjuvant CRT identifies patients who are unlikely to achieve a survival benefit from surgery. Moreover, findings of complete pathologic response, a low incidence of metastatic lymph nodes, a low incidence of margin positivity and reduced local recurrences when compared with patients who did not undergo neoadjuvant treatment [11,12,13,14] are compelling arguments of the local impact of CRT [15,16,17,18,19,22,23,24,25,26,27]. …”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant 5 Fluorouracil-Cisplatin Chemoradiation Effect on Survival in Patients with Resectable Pancreatic Head Adenocarcinoma: A Ten-Year Single Institution Experience

Turrini

Viret²,

Moureau-Zabotto³

et al. 2009

Oncology

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Objectives: It is the aim of this study to assess the outcome of patients who received neoadjuvant 5-fluorouracil-cisplatin chemoradiation (CRT) for stage I/III pancreatic adenocarcinoma. Methods: Eligible patients (n = 101) received radiation therapy (45 Gy) associated with continuous infusion of 5-fluorouracil accompanied by a cisplatin bolus. Results: Of the 102 patients enrolled in the study, 26 patients had progression of cancer during treatment and were deemed unresectable; 1 patient died during CRT of septic shock. Sixty-two of 75 remaining patients underwent pancreaticoduodenectomy. The overall median survival of all 102 patients in the study was 17 months, with a 5-year survival of 10%. For patients who underwent resection, the median survival was 23 months. Correspondingly, the median survival was 11 months for the 40 unresected patients (p = 0.002). The 5-year survivals for resected and unresected patients were 18 and 0% (p = 0.01), respectively. A complete pathological response to neoadjuvant CRT was noted for 8 patients (13%). Margin and lymph node positivity was present in 5 (8%) and 15 (24%) patients, respectively. There was documented local recurrence in 8 (13%) and distant recurrence in 36 (58%) patients, with the liver being the most common site. Conclusion: Neoadjuvant 5-fluorouracil-based CRT had a limited impact on survival but appeared to be associated with improved local control.

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“…The histological response of tumors to neoadjuvant chemoradiation has been shown to be an important prognostic factor in which patients with complete pathologic response have improved overall survival [37,38]. However, the timing between completion of radiation and surgical resection remains unclear.…”

Section: Neoadjuvant Chemoradiationmentioning

confidence: 99%

Treatment of Locally Advanced Pancreatic Ductal Adenocarcinoma

Loehrer¹,

Ferrone²

2016

Dig Surg

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Pancreatic ductal adenocarcinoma (PDAC) is increasingly common and a leading cause of cancer-related mortality. Surgery remains the only possibility for cure. Upwards of 40% of patients present with locally advanced PDAC (LA-PDAC), where management strategies continue to evolve. In this review, we highlight current trends in neoadjuvant chemotherapy, surgical resection, and other multimodality approaches for patients with LA-PDAC. Despite promising early results, additional work is needed to more accurately and appropriately tailor treatment for patients with LA-PDAC.

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Significance of Histological Response to Preoperative Chemoradiotherapy for Pancreatic Cancer

Abstract: Histological response to neoadjuvant CRT--as measured by residual tumor load--may be useful as a surrogate marker for treatment efficacy. Characterization of the tumor cells that survive neoadjuvant CRT may help us to identify new or more appropriate targets for systemic therapy.

Cited by 148 publications

References 20 publications

Neoadjuvant chemotherapy in borderline resectable pancreatic cancer: A case report

Neoadjuvant chemotherapy in borderline resectable pancreatic cancer: A case report

Neoadjuvant 5 Fluorouracil-Cisplatin Chemoradiation Effect on Survival in Patients with Resectable Pancreatic Head Adenocarcinoma: A Ten-Year Single Institution Experience

Treatment of Locally Advanced Pancreatic Ductal Adenocarcinoma

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