Downstaging in Pancreatic Cancer: A Matched Analysis of Patients Resected Following Systemic Treatment of Initially Locally Unresectable Disease

Bickenbach, Kai; Gönen, Mithat; Tang, Laura H.; O'Reilly, Eileen Mary; Goodman, Karyn A.; Brennan, Murray F.; D’Angelica, Michael I.; DeMatteo, Ronald P.; Fong, Yuman; Jarnagin, William R.; Allen, Peter J.

doi:10.1245/s10434-011-2156-7

Cited by 53 publications

(34 citation statements)

References 19 publications

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“…This therapeutic goal is of importance, as a previous study by our group has suggested that patients who are able to undergo resection following initial systemic treatment of stage III disease experience similar survival to those whose tumors are initially resected 5 . Within the current study, 31% of patients initially deemed unresectable eventually underwent resection.…”

Section: Discussionmentioning

confidence: 99%

“…Objective response rate(ORR) was defined as the percentage of patients who had a decrease >30% in the greatest dimension of the primary tumor or complete disappearance of the primary tumor. Pathologic response was also recorded, and the guidelines utilized for determining this response have been previously reported 5 .…”

Section: Methodsmentioning

confidence: 99%

“…Conversion from unresectable to resectable disease with induction therapy is an important therapeutic goal for stage III patients, which studies suggest is associated with improved survival 5 . During the pre-FOLFIRINOX era, the conversion rates of stage III patients with induction therapy ranged between 7–19% 6–13 .…”

Section: Introductionmentioning

confidence: 99%

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FOLFIRINOX Induction Therapy for Stage 3 Pancreatic Adenocarcinoma

et al. 2015

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Background FOLFIRINOX therapy for pancreatic ductal adenocarcinoma (PDAC) has been reported to result in objective response rates that are 2–3 fold higher than other regimens. Our goal was to assess response rates and resection rates in locally unresectable (stage III) patients initially treated with induction FOLFIRINOX. Methods The institutional cancer database was queried for patients treated with induction FOLFIRINOX therapy between 2010–2013. Patients were included if they were treated at our institution for stage III PDAC (locally unresectable) that had been adjudicated at a weekly multidisciplinary tumor board. Results One hundred and one patients were identified. The median age was 64 years (range:37–81) and the median follow-up was 12 months (range:3–37). Patients received a median of six cycles of induction FOLFIRINOX(range:1–20). No grade 4–5 toxicity was recorded. At initial restaging(median of 3 months following diagnosis), 23 patients(23%) had developed distant metastases, 15 patients(15%) underwent resection, and 63 patients(63%) proceeded to chemoradiation. Within the group of 63patients who proceeded to chemoradiation(median of 9 months following diagnosis), an additional 16 patients(16%) underwent resection and 5(5%) developed metastases. A partial radiographic response was observed in 29% of all patients, which was associated with the ability to perform resection(p=0.004). The median overall survival within the group who progressed on FOLFIRINOX and the group who did not progress were 11 and 26months, respectively. Conclusion Nearly a third of patients who had been initially identified to have stage III pancreatic carcinoma and had been treated with FOLFIRINOX responded radiographically and underwent tumor resection.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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FOLFIRINOX Induction Therapy for Stage 3 Pancreatic Adenocarcinoma

et al. 2015

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“…Although many improvements in chemotherapy and radiation therapy have been made, pancreaticoduodenectomy (PD or Whipple's procedure) remains the only chance for a cure and the standard of care for resectable pancreatic head adenocarcinoma. In patients with borderline resectable or locally advanced pancreatic cancer, curative surgical resection can be achieved after neoadjuvant chemotherapy and/or chemoradiation in the case of downstaging 2 . Unlike in historic series, PD has become a safer procedure with an important decrease in mortality rates.…”

Section: Introductionmentioning

confidence: 99%

Does neoadjuvant therapy for pancreatic head adenocarcinoma increase postoperative morbidity? A systematic review of the literature with meta‐analysis

Araújo

Silva

Souza

et al. 2020

Journal of Surgical Oncology

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Neoadjuvant treatment (NT) for pancreatic head cancer may allow some patients to undergo curative resection, but its impact on postoperative complications remains unclear. A systematic review and meta‐analysis were performed to compare overall postoperative morbidity, pancreatic fistula, and mortality between patients who underwent upfront surgery and those who underwent neoadjuvant therapy first. Forty‐five studies with 3359 patients were included. No significant differences in morbidity and mortality rates associated with NT for pancreatic head cancer were detected in this study.

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“…4 Complete surgical resection remains the best option for meaningful patient survival; however, only about 20% of patients who present with PDAC are candidates for resection. 4 Complete surgical resection remains the best option for meaningful patient survival; however, only about 20% of patients who present with PDAC are candidates for resection.…”

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Value of Intraoperative Neck Margin Analysis During Whipple for Pancreatic Adenocarcinoma

Kooby¹,

Lad²,

Squires³

et al. 2014

Annals of Surgery

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Downstaging in Pancreatic Cancer: A Matched Analysis of Patients Resected Following Systemic Treatment of Initially Locally Unresectable Disease

Abstract: In this study, patients who were able to undergo resection following treatment of initial stage III pancreatic cancer experienced survival similar to those who were initially resectable. Resection is indicated in this highly select group of patients.

Cited by 53 publications

References 19 publications

FOLFIRINOX Induction Therapy for Stage 3 Pancreatic Adenocarcinoma

FOLFIRINOX Induction Therapy for Stage 3 Pancreatic Adenocarcinoma

Does neoadjuvant therapy for pancreatic head adenocarcinoma increase postoperative morbidity? A systematic review of the literature with meta‐analysis

Value of Intraoperative Neck Margin Analysis During Whipple for Pancreatic Adenocarcinoma

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