Survival of patients with resectable pancreatic cancer who received neoadjuvant therapy

Christians, Kathleen K.; Heimler, Jonathan W.; George, Ben; Ritch, Paul S.; Erickson, Beth; Johnston, Fabian M.; Tolat, Parag; Foley, W. Dennis; Evans, Douglas B.; Tsai, Susan

doi:10.1016/j.surg.2015.09.018

Cited by 116 publications

(79 citation statements)

References 26 publications

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“…[12–15] More recent studies evaluating the impact of neoadjuvant therapy on highly selected patients with resectable disease have yielded median survival times as long as 44 months in patients with R0, node negative disease. [16–18]…”

Section: Introductionmentioning

confidence: 99%

Palliative Care for Pancreatic and Periampullary Cancer

Perone

Riall

Olino

2016

Surgical Clinics of North America

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Synopsis Most patients with pancreatic cancer will present with metastatic or locally advanced disease. [1–3] Unfortunately, the majority of patients with localized disease will recur even after multi-modality therapy including surgical resection combined with neoadjuvant or adjuvant chemotherapy. As such, pancreatic cancer patients arrive at a common endpoint where decisions pertaining to palliative care come to the forefront. This chapter summarizes surgical, endoscopic and other palliative techniques for relief of obstructive jaundice, relief of duodenal or gastric outlet obstruction, and relief of pain due to invasion of the celiac plexus. It also introduces the utility of the palliative care triangle in clarifying a patient’s and family’s goals to guide decision-making and choose “the right treatment, for the right patient, in the right setting.”

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Section: Introductionmentioning

confidence: 99%

Palliative Care for Pancreatic and Periampullary Cancer

Perone

Riall

Olino

2016

Surgical Clinics of North America

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“…1,2 After diagnosis of PDAC, patient selection for surgical resection is challenging at multiple stages during the procedure: detection of occult distant metastases, assessment of the extent of the primary tumor, peritumoral lymph nodes (LN), and the resection margins. Surgeons address two critical decisions during the procedure that will determine the long-term survival of pancreatic cancer: the absence of metastatic and regional disease and cancer-free margins.…”

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confidence: 99%

Intraoperative Pancreatic Cancer Detection using Tumor-Specific Multimodality Molecular Imaging

et al. 2018

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Background Operative management of pancreatic ductal adenocarcinoma (PDAC) is complicated by several key decisions during the procedure. Identification of metastatic disease at the outset and, when none is found, complete (R0) resection of primary tumor are key to optimizing clinical outcomes. The use of tumor-targeted molecular imaging, based on photoacoustic and fluorescence optical imaging, can provide crucial information to the surgeon. The first-in-human use of multimodality molecular imaging for intraoperative detection of pancreatic cancer is reported using cetuximab-IRDye800, a near-infrared fluorescent agent that binds to epidermal growth factor receptor. Methods A dose-escalation study was performed to assess safety and feasibility of targeting and identifying PDAC in a tumor-specific manner using cetuximab-IRDye800 in patients undergoing surgical resection for pancreatic cancer. Patients received a loading dose of 100 mg of unlabeled cetuximab before infusion of cetuximab-IRDye800 (50 mg or 100 mg). Multi-instrument fluorescence imaging was performed throughout the surgery in addition to fluorescence and photoacoustic imaging ex vivo. Results Seven patients with resectable pancreatic masses suspected to be PDAC were enrolled in this study. Fluorescence imaging successfully identified tumor with a significantly higher mean fluorescence intensity in the tumor (0.09 ± 0.06) versus surrounding normal pancreatic tissue (0.02 ± 0.01), and pancreatitis (0.04 ± 0.01; p < 0.001), with a sensitivity of 96.1% and specificity of 67.0%. The mean photoacoustic signal in the tumor site was 3.7-fold higher than surrounding tissue. Conclusions The safety and feasibilty of intraoperative, tumor-specific detection of PDAC using cetuximab-IRDye800 with multimodal molecular imaging of the primary tumor and metastases was demonstrated.

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“…First, the present study [26] included two patients who experienced complete remission and achieved 5-year survival. There have been several reports [27,28] of pathological complete remission with neoadjuvant therapy, such as 5-FU-and gemcitabine-based regimens with or without radiotherapy, in patients with PDAC, with rates of 3.3% and 7.0%, respectively. Pathological tumor response in post-therapy specimens may be used as a successful surrogate for longer recurrence-free survival in patients with resectable PDAC.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of preoperative 5-fluorouracil, cisplatin, and mitomycin C in combination with radiotherapy in patients with resectable and borderline resectable pancreatic cancer: a long-term follow-up study

et al. 2019

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Background: We aimed to evaluate the efficacy and safety of 5-fluorouracil-based neoadjuvant chemoradiotherapy (NACRT) in patients with resectable/borderline resectable pancreatic ductal adenocarcinoma (PDAC). Methods: This retrospective study investigated the clinicopathological features and > 5-year survival of patients with T3/T4 PDAC who underwent NACRT at our institute between 2003 and 2012. Results: Seventeen resectable and eight borderline resectable patients were included. The protocol treatment completion and resection rates were 92.0% and 68.0%, respectively. Two patients failed to complete chemotherapy owing to cholangitis or anorexia. Common grade 3 toxicities included anorexia (12%), neutropenia (4%), thrombocytopenia (4%), anemia (4%), and leukopenia (12%). Pathologically negative margins were achieved in 94.1% of patients who underwent pancreatectomy. Pathological response according to Evans' classification was grade IIA in 10 patients (58.8%), IIB in 5 patients (29.4%), and IV in 2 patients (11.8%). Postoperative pancreatic fistulas were observed in four patients (23.5%), delayed gastric emptying in one patient (5.9%), and other operative morbidities in four patients (23.5%). The 1-, 2-, 5-, and 10-year overall survival rates were 73.9%, 60.9%, 60.9%, and 39.1%, respectively (median follow-up period, 80.3 months). Conclusions: NACRT is tolerable and beneficial for resectable/borderline resectable PDAC, even in the long-term.

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Survival of patients with resectable pancreatic cancer who received neoadjuvant therapy

Cited by 116 publications

References 26 publications

Palliative Care for Pancreatic and Periampullary Cancer

Palliative Care for Pancreatic and Periampullary Cancer

Intraoperative Pancreatic Cancer Detection using Tumor-Specific Multimodality Molecular Imaging

Efficacy and safety of preoperative 5-fluorouracil, cisplatin, and mitomycin C in combination with radiotherapy in patients with resectable and borderline resectable pancreatic cancer: a long-term follow-up study

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