Assessment of pathologic response after preoperative chemoradiotherapy and surgery in pancreatic adenocarcinoma

Moutardier, Vincent; Magnin, Valérie; Turrini, Olivıer; Viret, F.; Hennekinne-Mucci, S.; Gonçalves, A; Pesenti, Christian; Guiramand, Jérôme; Lelong, Bernard; Giovannini, Marc; Monges, Geneviève; Houvenaeghel, Gilles; Delpero, Jean‐Robert

doi:10.1016/j.ijrobp.2004.04.004

Cited by 97 publications

(52 citation statements)

References 27 publications

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“…Similar to previous findings, only 45% of patients were able to undergo surgical resection and median OS for patients who had curative surgery was only 9.7 months, inferior to historic controls for patients treated with surgery alone [7]. Another neoadjuvant treatment strategy incorporating 5-FU, cisplatin and concurrent radiation has been reported in several retrospective studies [9,[17][18]34,[38][39]. The results of these studies have been disappointing as they do not appear to be significantly improved over those using adjuvant therapies, and efforts to improve on these outcomes have led to studies evaluating neoadjuvant chemoradiation with other agents.…”

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confidence: 83%

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The Role of Neoadjuvant Therapy in Pancreatic Cancer: A Review

et al. 2016

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Controversy remains regarding neoadjuvant approaches in the treatment of pancreatic cancer. Neoadjuvant therapy has several potential advantages over adjuvant therapy including earlier delivery of systemic treatment, in vivo assessment of response, increased resectability rate in borderline resectable patients and increased margin-negative resection rate. At present, there are no randomized data favoring neoadjuvant over adjuvant therapy and multiple neoadjuvant approaches are under investigation. Combination chemotherapy regimens including 5-fluorouracil, irinotecan and oxaliplatin, gemcitabine with or without abraxane, or docetaxel and capecitabine have been used in the neoadjuvant setting. Radiation and chemoradiation have also been incorporated into neoadjuvant strategies, and delivery of alternative fractionation regimens is being explored. This review provides an overview of neoadjuvant therapies for pancreatic cancer. KEYWORDS• 5-fluorouracilPancreatic adenocarcinoma is considered one of the most aggressive malignancies. Most patients are diagnosed with advanced stage disease and only 15-20% of patients are considered candidates for curative resection. An additional 5-10% is diagnosed with borderline resectable or locally advanced disease. Although surgical resection is considered the only potentially curative treatment, resection alone results in low cure rates with median overall survival (OS) rates of approximately 20 months [1,2]. Pancreatic cancer is biologically aggressive and lacks therapeutic agents that are effective against micrometastases. Even in patients who undergo complete surgical resection followed by adjuvant chemotherapy with or without radiation, the risk for systemic recurrence can be as high as 77%, and may be either locoregional or distant in nature [3].Response rates to adjuvant therapies are variable and there is no reliable method to identify which patients will respond to treatment. Nonetheless, some randomized studies demonstrate OS and disease-free survival advantages associated with adjuvant therapies for resectable pancreatic cancer [4,5].Unlike adjuvant therapy, a neoadjuvant treatment approach potentially allows for in vivo assessment of tumor response. In addition, the use of early systemic therapy prior to surgery allows treatment of radiographically undetectable metastatic disease in some patients. It has been reported that 670REviEW Russo, Ammori, Eads & Dorth future science group disease progression occurs in 45-74% following neoadjuvant chemoradiation [6][7][8][9] and 30-78% following neoadjuvant chemotherapy [10] . Noncurative surgery and its associated risks can be avoided in patients who demonstrate disease progression following n eoadjuvant therapy.Neoadjuvant treatment also has the potential to improve compliance [11] as adjuvant therapy is frequently delayed due to recovery from surgery. It is estimated that approximately 25% of patients undergoing curative resection for pancreatic cancer do not receive the planned postoperative treatment due to surgical co...

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confidence: 83%

“…REviEW Russo, Ammori, Eads & Dorth future science group disease progression occurs in 45-74% following neoadjuvant chemoradiation [6][7][8][9] and 30-78% following neoadjuvant chemotherapy [10] . Noncurative surgery and its associated risks can be avoided in patients who demonstrate disease progression following n eoadjuvant therapy.…”

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confidence: 99%

The Role of Neoadjuvant Therapy in Pancreatic Cancer: A Review

et al. 2016

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“…Computed tomography detected responses in pancreatic cancer are slow and infrequent after chemoradiation [2][3][4] and underestimate the effectiveness of neoadjuvant therapy in patients with resectable disease [5,6]. In our prior series of 74 patients with unresectable pancreatic cancer treated with gemcitabine and radiotherapy, 11 patients (15%) achieved a CT detected partial response by RECIST, and no one achieved a complete response [4].…”

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confidence: 92%

A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer

Cuneo¹,

Chenevert²,

Feng³

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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“…There are some grading systems for the extent of residual tumor in PDA after CRT, 6,9,[17][18][19] but systems for assessing histological therapeutic effect have not yet been standardized. For example, Evans et al proposed criteria based on the amount of destruction of tumor cells, paying attention to acellular mucin pools, 18 whereas Le Scodan et al proposed classification based on the proportions of degenerative tumor cells present.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13][14][15] However, very few studies have analyzed the clinicopathological significance of pCR in patients with PDA who received neoadjuvant therapy. 9,16,17 Here we report two cases of pCR to NACRT in PDA, including detailed pathological findings of resected tissues.…”

Section: Introductionmentioning

confidence: 94%

Two Cases of Pathological Complete Response to Neoadjuvant Chemoradiation Therapy in Pancreatic Cancer

et al. 2015

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Neoadjuvant chemoradiation therapy (NACRT) is increasingly used in patients with a potentially or borderline resectable pancreatic ductal adenocarcinoma (PDA) and it has been shown to improve survival and reduce locoregional metastatic disease. It is rare for patients with PDA to have a pathological complete response (pCR) to NACRT, but such patients reportedly have a good prognosis. We report the clinicopathological findings of two cases of pCR to NACRT in PDA. Both patients underwent pancreatectomy after NACRT (5-fluorouracil, mitomycin C, cisplatin, and radiation). Neither had residual invasive carcinoma and both showed extensive fibrotic regions with several ducts regarded as having pancreatic intraepithelial neoplasia 3/carcinoma in situ in their post-therapy specimens. It is noteworthy that both patients had a history of a second primary cancer. They both had comparatively good outcomes: one lived for 9 years after the initial pancreatectomy and the other is still alive without recurrence after 2 years.

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Assessment of pathologic response after preoperative chemoradiotherapy and surgery in pancreatic adenocarcinoma

Cited by 97 publications

References 27 publications

The Role of Neoadjuvant Therapy in Pancreatic Cancer: A Review

The Role of Neoadjuvant Therapy in Pancreatic Cancer: A Review

A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer

Two Cases of Pathological Complete Response to Neoadjuvant Chemoradiation Therapy in Pancreatic Cancer

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