Neoadjuvant treatment for borderline resectable pancreatic adenocarcinoma is associated with higher R0 rate compared to upfront surgery

Terlizzi, Mario; Buscail, Étienne; Boussari, Olayidé; Adgie, S.; Leduc, Nicolas; Terrebonne, Éric; Smith, Denis; Blanc, Jean‐Frédéric; Lapuyade, Bruno; Laurent, Alexis; Chiche, Laurent; Belleannée, Geneviève; Malicot, Karine Le; Trouette, R.; Pouypoudat, C.; Vendrely, V.

doi:10.1080/0284186x.2021.1944662

Cited by 7 publications

(8 citation statements)

References 38 publications

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“…After a full-text assessment of 34 studies, 15 were excluded according to the exclusion criteria. Finally, 19 publications with 21 data sets were included in the analysis, involving a total of 2906 patients (NAT, 1516; UFS, 1390) ( Figure 1 ) [ 6 , 9 , 10 , 12 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…When the study included patients with other types of pancreatic cancer and BRPC, only the BRPC patient pool was analyzed in this study. Thirteen studies (15 data sets) performed ITT analyses, [ 6 , 10 , 12 , 20 , 21 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ], while six studies presented the data of resected patients [ 9 , 17 , 18 , 19 , 22 , 30 ]. With regard to the chemotherapy regimen in the neoadjuvant setting, 16 studies used gemcitabine [ 6 , 9 , 10 , 12 , 17 , 18 , 19 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ] and 4 of those used gemcitabine plus nab-paclitaxel [ 6 , 24 , 26 , 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…With regard to the chemotherapy regimen in the neoadjuvant setting, 16 studies used gemcitabine [ 6 , 9 , 10 , 12 , 17 , 18 , 19 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ] and 4 of those used gemcitabine plus nab-paclitaxel [ 6 , 24 , 26 , 27 ]. Five studies described the FOLFIRINOX-including regimen [ 22 , 28 , 29 , 30 , 31 ]. Ren et al and Terlizzi et al only investigated the FOLFIRINOX regimen [ 30 , 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…Five studies described the FOLFIRINOX-including regimen [ 22 , 28 , 29 , 30 , 31 ]. Ren et al and Terlizzi et al only investigated the FOLFIRINOX regimen [ 30 , 31 ]. As a part of NAT, radiotherapy was administered in 14 of 19 studies [ 6 , 9 , 12 , 17 , 18 , 19 , 20 , 22 , 23 , 25 , 28 , 29 , 30 , 31 ], while 7 studies used concurrent chemoradiation therapy (CCRT) [ 9 , 12 , 18 , 19 , 20 , 22 , 23 ].…”

Section: Resultsmentioning

confidence: 99%

“… Overall survival of NAT versus UFS ( A ) in intention-to-treat analysis [ 6 , 10 , 12 , 20 , 21 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 31 ]; ( B ) in resected group [ 6 , 9 , 12 , 17 , 18 , 19 , 21 , 22 , 23 , 25 , 27 , 28 , 30 , 31 ]. Red squares correspond to individual studies.…”

Section: Figurementioning

confidence: 99%

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Oncologic Benefits of Neoadjuvant Treatment versus Upfront Surgery in Borderline Resectable Pancreatic Cancer: A Systematic Review and Meta-Analysis

Jung

Kim

Kang

et al. 2022

Cancers

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Neoadjuvant treatment (NAT) followed by surgery is the primary treatment for borderline resectable pancreatic cancer (BRPC). However, there is limited high-level evidence supporting the efficacy of NAT in BRPC. PubMed was searched to identify studies that compared the survival between BRPC patients who underwent NAT and those who underwent upfront surgery (UFS). The overall survival (OS) was compared using intention-to-treat (ITT) analysis. A total of 1204 publications were identified, and 19 publications with 21 data sets (2906 patients; NAT, 1516; UFS, 1390) were analyzed. Two randomized controlled trials and two prospective studies were included. Thirteen studies performed an ITT analysis, while six presented the data of resected patients. The NAT group had significantly better OS than the UFS group in the ITT analyses (HR: 0.63, 95% CI = 0.53–0.76) and resected patients (HR: 0.68, 95% CI = 0.60–0.78). Neoadjuvant chemotherapy with gemcitabine or S-1 and FOLFIRINOX improved the survival outcomes. Among the resected patients, the R0 resection and node-negativity rates were significantly higher in the NAT group. NAT improved the OS, R0 resection rate, and node-negativity rate compared with UFS. Standardizing treatment regimens based on high-quality evidence is fundamental for developing an optimal protocol.

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