Outcomes of patients with initially locally advanced pancreatic adenocarcinoma who did not benefit from resection: a prospective cohort study

Abstract

Background: The current study aimed to evaluate the outcomes of patients with unresectable non-metastatic locally advanced pancreatic adenocarcinoma (LAPA) who did not benefit from resection considering the treatment strategy in the clinical settings. Methods: Between 2010 and 2017, a total of 234 patients underwent induction chemotherapy for LAPA that could not be treated with surgery. After oncologic restaging, continuous chemotherapy or chemoradiation (CRT) was decided for patients without metastatic disease. The Kaplan-Meier method was used to determine overall survival (OS), and the Wilcoxon test to compare survival curves. Multivariate analysis was performed using the stepwise logistic regression method. Results: FOLFIRINOX was the most common induction regimen (168 patients, 72%), with a median of 6 chemotherapy cycles and resulted in higher OS, compared to gemcitabine (19 vs. 16 months, hazard ratio (HR) = 1.2, 95% confidence interval: 0.86-1.6, P = .03). However, no difference was observed after adjusting for age (≤75 years) and performance status score (0-1). At restaging, 187 patients (80%) had non-metastatic disease: CRT was administered to 126 patients (67%) while chemotherapy was continued in 61 (33%). Patients who received CRT had characteristics comparable to those who continued with chemotherapy, with similar OS. They also had longer progression-free survival (median 13.3 vs. 9.6 months, HR = 1.38, 95% confidence interval: 1-1.9, P < .01) and limited short-term treatment-related toxicity. Conclusions: The median survival of patients who could not undergo surgery was 19 months. Hence, CRT should not be eliminated as a treatment option and may be useful as a part of optimised sequential chemotherapy for both local and metastatic disease.

Neoadjuvant Stereotactic Body Radiotherapy After Upfront Chemotherapy Improves Pathologic Outcomes Compared With Chemotherapy Alone for Patients With Borderline Resectable or Locally Advanced Pancreatic Adenocarcinoma Without Increasing Perioperative Toxicity

“…3,[30][31][32] One study compared FFX followed by CRT or chemotherapy alone, and as in our study, outcomes were improved with the addition of CRT. 33 A single-arm study of 50 patients in Italy with neoadjuvant FFX and SBRT reported that SBRT delivery to the 39 patients without progression after FFX was associated with a significantly improved median OS (18 months in the SBRT group vs 5 months in the non-SBRT group). 34 After SBRT, seven patients had an RO resection and experienced a significantly better 3-year OS than nonresected patients (43% vs 6.5%).…”

[18F]FDG PET/MRI enables early chemotherapy response prediction in pancreatic ductal adenocarcinoma

“…a single infusion of FOLFIRINOX). Due to the recent advancement in neoadjuvant therapy regimen, patients with LAPC would in particular profit from a more detailed therapy monitoring since in this patient collective neoadjuvant induction therapy aims at conversion to a resectable tumor stage [ 34 – 36 ].…”

Pancreatic Ductal Adenocarcinoma: Current and Emerging Therapeutic Uses of Focused Ultrasound

“…The combination of radiation therapy and chemotherapy is not recommended, as it has not demonstrated any survival advantages [ 12 , 13 ]. Unfortunately, most of these patients have a very limited chance of undergoing surgery even after chemotherapy [ 14 ]. In this context, pain management has an important place.…”