Long‐term survival benefit of upfront chemotherapy in patients with newly diagnosed borderline resectable pancreatic cancer

Shrestha, Binod; Sun, Yifei; Faisal, Farzana A.; Kim, Victoria; Soares, Kevin C.; Blair, Alex B.; Herman, Joseph M.; Narang, Amol; Dholakia, Avani Satish; Rosati, Lauren M.; Hacker-Prietz, Amy; Chen, Linda; Laheru, Daniel A.; Jesus-Acosta, Ana De; Le, Dung T.; Donehower, Ross C.; Azad, N.; Díaz, Luis A.; Murphy, Adrian; Lee, Valerie; Fishman, Elliot K.; Hruban, Ralph H.; Liang, Tingbo; Cameron, John L.; Makary, Martin A.; Weiss, Matthew J.; Ahuja, Nita; He, Jin; Wolfgang, Christopher L.; Huang, Chiung Yu; Li, Zheng

doi:10.1002/cam4.1104

Cited by 20 publications

(17 citation statements)

References 21 publications

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“…Of those who underwent surgery, an R0 was achieved in 85% and R1 in the remaining 15%. This is similar to the findings of other studies that have evaluated the sensitivity of imaging to determine resectability in these patients 17,18 .…”

Section: Discussionsupporting

confidence: 89%

The Role of Radiological Parameters in Assessing Response to Neoadjuvant Therapy in Borderline Resectable Pancreatic Cancer

Hussien

Sallam

Abdelkawi

et al. 2020

Kasr-Al-Aini J.of Clin. Onc. and Nuc. Med.

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Section: Discussionsupporting

confidence: 89%

The Role of Radiological Parameters in Assessing Response to Neoadjuvant Therapy in Borderline Resectable Pancreatic Cancer

Hussien

Sallam

Abdelkawi

et al. 2020

Kasr-Al-Aini J.of Clin. Onc. and Nuc. Med.

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“…This is similar to the findings of other studies that have evaluated the sensitivity of imaging to determine resectability in these patients. 27–29 …”

Section: Discussionmentioning

confidence: 99%

Outcome of Patients with Borderline Resectable Pancreatic Cancer in the Contemporary Era of Neoadjuvant Chemotherapy

Javed

Wright

Siddique

et al. 2019

Journal of Gastrointestinal Surgery

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Introduction Approximately, 20% of patients with pancreatic ductal adenocarcinoma have resectable disease at diagnosis. Given improvements in locoregional and systemic therapies, some patients with borderline resectable pancreatic cancer (BRPC) can now undergo successful resection. The outcomes of patients with BRPC after neoadjuvant therapy remain unclear. Methods A prospectively maintained single-institution database was utilized to identify patients with BRPC who were managed at the Johns Hopkins Pancreas Multidisciplinary Clinic (PMDC) between 2013 and 2016. BRPC was defined as any tumor that presented with radiographic evidence of the involvement of the portal vein (PV) or superior mesenteric vein (SMV) that was deemed to be technically resectable (with or without the need for reconstruction), or the abutment (< 180° involvement) of the common hepatic artery (CHA) or superior mesenteric artery (SMA), in the absence of involvement of the celiac axis (CA). We collected data on treatment, the course of the disease, resection rate, and survival. Results Of the 866 patients evaluated at the PMDC during the study period, 151 (17.5%) were staged as BRPC. Ninety-six patients (63.6%) underwent resection. Neoadjuvant chemotherapy was administered to 142 patients (94.0%), while 78 patients (51.7%) received radiation therapy in the neoadjuvant setting. The median overall survival from the date of diagnosis, of resected BRPC patients, was 28.8 months compared to 14.5 months in those who did not (p < 0.001). Factors associated with increased chance of surgical resection included lower ECOG performance status (p = 0.011) and neck location of the tumor (p = 0.001). Forty-seven patients with BRPC (31.1%) demonstrated progression of disease; surgical resection was attempted and aborted in 12 patients (7.9%). Eight patients (5.3%) were unable to tolerate chemotherapy; six had disease progression and two did not want to pursue surgery. Lastly, four patients (3.3%) were conditionally unresectable due to medical comorbidities at the time of diagnosis due to comorbidities and failed to improve their status and subsequently had progression of the disease. Conclusion After initial management, 31.1% of patients with BRPC have progression of disease, while 63.6% of all patients successfully undergo resection, which was associated with improved survival. Factors associated with increased likelihood of surgical resection include lower ECOG performance status and tumor location in the neck.

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“…The theoretical advantages of an neoadjuvant approach in PDAC includes potential downstage of disease, increase of negative resection margins rates, early treatment for micrometastatic disease and identification of patients with an aggressive tumor biology in whom resection offers no survival benefits. Thus, recent studies have shown the benefit of neo-adjuvant chemotherapy with FOLFIRINOX or gemcitabine and nab-paclitaxel for borderline resectable PDAC (64)(65)(66)(67).…”

Section: Neoadjuvant Therapies In Pdacmentioning

confidence: 99%

Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

Popescu¹,

Dumitraşcu²

2017

SGO

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Pancreatic ductal adenocarcinoma (PDAC) is an important healthcare problem because is a leading cause of death by cancer. PDAC is a highly lethal disease with a very dismal prognosis. Most patients present advanced disease at diagnosis. The management of a patient diagnosed with PDAC should be discussed in a multidisciplinary team in high-volume centers. Pancreatectomy represents the single hope of long-term survival for a patient with PDAC but the resectability rate is less than 20% of the cases. Several progresses were observed in the last years regarding the surgical and oncological approach for PDAC. The aim of the paper is to make a brief review of the current onco-surgical strategies available for patients with PDAC.

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Long‐term survival benefit of upfront chemotherapy in patients with newly diagnosed borderline resectable pancreatic cancer

Cited by 20 publications

References 21 publications

The Role of Radiological Parameters in Assessing Response to Neoadjuvant Therapy in Borderline Resectable Pancreatic Cancer

The Role of Radiological Parameters in Assessing Response to Neoadjuvant Therapy in Borderline Resectable Pancreatic Cancer

Outcome of Patients with Borderline Resectable Pancreatic Cancer in the Contemporary Era of Neoadjuvant Chemotherapy

Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

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