A reappraisal of preoperative chemoradiation for localized pancreatic head ductal adenocarcinoma in a 5-year single-institution experience

Moutardier, Vincent; Turrini, Olivıer; Huiart, Laëtitia; Viret, F.; Giovannini, Marc; Magnin, Valérie; Lelong, Bernard; Bories, Erwan; Guiramand, Jérôme; Sannini, Antoine; Houvenaeghel, Gilles; Blache, J.L.; Moutardier, J.C; Delpero, Jean‐Robert

doi:10.1016/j.gassur.2003.11.013

Cited by 33 publications

(38 citation statements)

References 31 publications

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“…The most important features of the individual studies that were included in the systematic review and meta‐analysis are summarized in Table 1 6 8, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25. The majority of studies6 8, 16, 17, 18, 19, 20, 21, 22, 23, 24 compared neoadjuvant chemoradiotherapy with primary surgery.…”

Section: Resultsmentioning

confidence: 99%

“…To analyse the impact of neoadjuvant therapy on local tumour recurrence, 12 studies6 8, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 were identified. Of those undergoing primary surgery, 27·7 per cent developed local recurrence compared with 12·4 per cent in the neoadjuvant group ( Fig .…”

Section: Resultsmentioning

confidence: 99%

“…In contrast to local recurrence, neoadjuvant therapy did not influence distant recurrence, which developed in 283 (50·2 per cent) of 564 patients in the neoadjuvant group versus 334 (49·6 per cent) of 674 in the surgery‐first group. The estimated RR of the meta‐analysis, which included 11 studies6 8, 16 18, 19, 20, 21, 22, 23, 24, 25, also failed to show any relevant impact of neoadjuvant therapy on the risk of distant metastasis (RR 1·02, 95 per cent c.i. 0·91 to 1·14; P = 0·78) ( Fig .…”

Section: Resultsmentioning

confidence: 99%

“…The site of recurrence may be even misinterpreted more frequently, as there is no clinical need to rule out peritoneal metastases if liver metastases have been detected radiologically. For this purpose, included studies were screened for information on follow‐up; all but two studies17 21 provided sufficient information. Follow‐up included CT of the abdomen every 3–6 months in six studies19 21, 22, 23, 24, 25, and ultrasound examination every 4 months and CT after 12 months or on demand in two studies18 20.…”

Section: Discussionmentioning

confidence: 99%

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Meta-analysis of the impact of neoadjuvant therapy on patterns of recurrence in pancreatic ductal adenocarcinoma

et al. 2018

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BackgroundNeoadjuvant therapy may increase the rate of radical tumour resection in patients with pancreatic cancer. Its impact on tumour recurrence has not been investigated fully. This study aimed to assess the impact of neoadjuvant therapy on patterns of recurrence.MethodsA systematic review was performed of articles identified through the PubMed, Scopus, Embase, Ovid and Google Scholar databases that analysed the relationship between neoadjuvant therapy and recurrence published to January 2016. The main endpoint was overall tumour recurrence. Other endpoints included local recurrence, any kind of distant, hepatic, pulmonary or peritoneal metastasis.ResultsA total of 4257 citations were reviewed. Twelve observational studies comprising 1365 patients were analysed. Neoadjuvant therapy significantly reduced the risk of overall (risk ratio (RR) 0·82, 95 per cent c.i. 0·74 to 0·90; P < 0·001) and local (RR 0·42, 0·32 to 0·55; P < 0·001) recurrence. Neoadjuvant therapy did not reduce the risk of any kind of distant (RR 1·02, 0·91 to 1·14; P = 0·78), hepatic (RR 0·86, 0·68 to 1·10; P = 0·23), pulmonary (RR 0·99, 0·37 to 2·66; P = 0·98) or peritoneal (RR 0·88, 0·57 to 1·38; P = 0·58) metastasis.ConclusionNeoadjuvant therapy reduced the risk of local recurrence but not that of distant metastasis.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Meta-analysis of the impact of neoadjuvant therapy on patterns of recurrence in pancreatic ductal adenocarcinoma

et al. 2018

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“…Preoperative treatment of resectable or borderline resectable cancer has several attractive benefits (Table 1) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. First, any partial response to treatment reduces the tumor volume, potentially increasing the likelihood of an R0 resection.…”

Section: Neoadjuvant (Preoperative) Crtmentioning

confidence: 99%

Chemoradiation in Pancreatic Adenocarcinoma: A Literature Review

Roy

Maraveyas

2010

The Oncologist

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Adenocarcinoma of the exocrine pancreas has an annual incidence of 7,400 cases in the U.K. In comparison with other common cancers of solid organs, namely, breast, colorectal, and prostate cancer, pancreatic cancer has a high morbidity and mortality. Radical resection is possible in only 15%-20% of patients, and only 3%-4% of all patients presenting with this condition achieve long-term control and cure. Various strategies in the form of neoadjuvant and adjuvant treatment have been employed over the years to improve outcome, with limited success. Systemic chemotherapy remains the gold standard in the metastatic setting in good performance status patients, and adjuvant chemotherapy after resection of localized and locally advanced cancer has been found to improve outcome. The role of radiotherapy, however, remains controversial and is an area that merits further investigation in well-conducted multicenter trials at various stages of the disease in combination with systemic agents and exploiting recent advances in the delivery of radiotherapy. In this article, we review the published literature on the use of chemoradiation as a modality in various stages of pancreatic adenocarcinoma and highlight areas that future trials in this field should target for a way forward in this malignancy. The Oncologist 2010;15:259 -269

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Meta-analysis of recurrence pattern after resection for pancreatic cancer

Tanaka

Mihaljevic

Probst

et al. 2019

British Journal of Surgery

123

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Background: Initial recurrence mapping of resected pancreatic ductal adenocarcinoma (PDAC) could help in stratifying patient subpopulations for optimal postoperative follow-up. The aim of this systematic review and meta-analysis was to investigate the initial recurrence patterns of PDAC and to correlate them with clinicopathological factors.Methods: MEDLINE and Web of Science databases were searched systematically for studies reporting first recurrence patterns after PDAC resection. Data were extracted from the studies selected for inclusion. Pooled odds ratios (ORs) and 95 per cent confidence intervals were calculated to determine the clinicopathological factors related to the recurrence sites. The weighted average of median overall survival was calculated.Results: Eighty-nine studies with 17 313 patients undergoing PDAC resection were included. The weighted median rates of initial recurrence were 20⋅8 per cent for locoregional sites, 26⋅5 per cent for liver, 11⋅4 per cent for lung and 13⋅5 per cent for peritoneal dissemination. The weighted median overall survival times were 19⋅8 months for locoregional recurrence, 15⋅0 months for liver recurrence, 30⋅4 months for lung recurrence and 14⋅1 months for peritoneal dissemination. Meta-analysis revealed that R1 (direct) resection (OR 2⋅21, 95 per cent c.i. 1⋅12 to 4⋅35), perineural invasion (OR 5⋅19, 2⋅79 to 9⋅64) and positive peritoneal lavage cytology (OR 5⋅29, 3⋅03 to 9⋅25) were significantly associated with peritoneal dissemination as initial recurrence site. Low grade of tumour differentiation was significantly associated with liver recurrence (OR 4⋅15, 1⋅71 to 10⋅07).

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A reappraisal of preoperative chemoradiation for localized pancreatic head ductal adenocarcinoma in a 5-year single-institution experience

Cited by 33 publications

References 31 publications

Meta-analysis of the impact of neoadjuvant therapy on patterns of recurrence in pancreatic ductal adenocarcinoma

Meta-analysis of the impact of neoadjuvant therapy on patterns of recurrence in pancreatic ductal adenocarcinoma

Chemoradiation in Pancreatic Adenocarcinoma: A Literature Review

Meta-analysis of recurrence pattern after resection for pancreatic cancer

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