Recurrence after neoadjuvant therapy and resection of borderline resectable and locally advanced pancreatic cancer

Groot, Vincent P.; Blair, Alex B.; Gemenetzis, Georgios; Ding, Ding; Burkhart, Richard A.; Yu, Jun; Rinkes, Inne H.M. Borel; Molenaar, I.; Cameron, John L.; Weiss, Matthew J.; Wolfgang, Christopher L.; He, Jin

doi:10.1016/j.ejso.2019.04.007

Cited by 65 publications

(86 citation statements)

References 42 publications

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“…The recurrence rate of pancreatic cancer after neoadjuvant therapy followed by resection or upfront resection was 53.5% and 88% in other studies; 4,16,17 however, the recurrence rate in the current study was 66.0% for patients with BRPC after neoadjuvant treatment and surgery. Interestingly, the recurrence rate was different after gemcitabine and FOLFIRINOX treatment (82.4 % vs 57.6%; p=0.013).…”

Section: Discussioncontrasting

confidence: 69%

Comparison of Clinical Outcomes of Borderline Resectable Pancreatic Cancer According to the Neoadjuvant Chemo-Regimens: Gemcitabine versus FOLFIRINOX

et al. 2021

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Background/Aims: Although many studies have reported the promising effect of neoadjuvant treatment for borderline resectable pancreatic cancer (BRPC) to increase resectability, only a few studies have recommended the use of firstline chemotherapeutic agents as neoadjuvant treatment for BRPC. The current study compared clinical outcomes between gemcitabine and FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) in patients with BRPC. Methods: In this single-center retrospective study, 100 BRPC patients treated with neoadjuvant chemotherapy and resection from 2008 to 2018 were reviewed. Clinical outcomes included overall survival, resectability, and recurrence patterns after gemcitabine or FOLFIRINOX treatment. Results: For neoadjuvant chemotherapy, gemcitabine was administered to 34 patients and FOLFIRINOX to 66. Neoadjuvant radiotherapy was administered to 27 patients (79.4%) treated with gemcitabine and 19 (28.8%) treated with FOL-FIRINOX (p<0.001). The 2-and 5-year survival rates (YSRs) were significantly higher after FOLFIRINOX (2YSR, 72.2%; 5YSR, 46.0%) than after gemcitabine (2YSR, 58.4%; 5YSR, 19.1%; p=0.041). The margin negative rate was comparable (gemcitabine, 94.1%; FOLFIRINOX, 92.4%; p=0.753), and the tumor size change in percentage showed only a marginal difference (gemcitabine, 20.5%; FOLFIRINOX, 29.0%; p=0.069). Notably, the metastatic recurrence rate was significantly lower in the FOLFIRINOX group (n=20, 52.6%) than in the gemcitabine group (n=22, 78.6%; p=0.001). The rate of adverse events after chemotherapy was significantly higher with FOLFIRINOX than with gemcitabine (43.9%, 20.6%, respectively; p=0.037). Conclusions: FOLFIRINOX provided more clinical and oncological benefit than gemcitabine, with significantly higher overall survival and lower cumulative recurrence rates in BRPC. However, since FOLFIRINOX causes more adverse effects, the regimen should be individualized based on patient's general condition and clinical status.

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Section: Discussioncontrasting

confidence: 69%

Comparison of Clinical Outcomes of Borderline Resectable Pancreatic Cancer According to the Neoadjuvant Chemo-Regimens: Gemcitabine versus FOLFIRINOX

et al. 2021

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“…Most patients received Gemcitabine-based NAT (24 studies [ 6 , 7 , 8 , 25 , 26 , 27 , 28 , 29 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ], 62%, 851/1382). Fluoropyrimidines (20%, 282/1382) and FOLFIRINOX (13%, 182/1382) based regimens were not uncommon, however, platinum-based and plant alkaloid regimens were rare (7% 97/1382 and 2% 23/1382 respectively) ( Table S3 ).…”

Section: Resultsmentioning

confidence: 99%

“…Recurrence patterns included overall recurrence rates, time to first recurrence and recurrence-free survival rates. Overall recurrence was defined by the first presentation of previously unknown disease activity during postoperative follow-up [ 25 ]. Locoregional recurrence was the presence of tumour recurrence at the site of previous resection or in surrounding lymph nodes (LN).…”

Section: Methodsmentioning

confidence: 99%

“…However, if baseline characteristic data or outcome data were not reported for propensity score matching, the unmatched data was used [ 28 ]. Historic [ 25 ] or unpublished [ 39 ] US cohorts were utilised if baseline characteristics were reported. Data for baseline characteristics was commonly reported for the entire study population irrespective of those who subsequently underwent resection.…”

Section: Methodsmentioning

confidence: 99%

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Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-Analysis

Ratnayake

Savastyuk

Nayar

et al. 2020

JCM

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Background: Neoadjuvant therapy (NAT) represents a paradigm shift in the management of patients with pancreatic ductal adenocarcinoma (PDAC) with perceived benefits including a higher R0 rate. However, it is unclear whether NAT affects the sites and patterns of recurrence after surgery. This review seeks to compare sites and patterns of recurrence after resection between patients undergoing upfront surgery (US) or after NAT. Methods: The EMBASE, SCOPUS, PubMed, and Cochrane library databases were systematically searched to identify eligible studies that compare recurrence patterns between patients who had NAT (followed by resection) with those that had US. The primary outcome included site-specific recurrence. Results: 26 articles were identified including 4986 patients who underwent resection. Borderline resectable pancreatic cancer (BRPC, 47% 1074/2264) was the most common, followed by resectable pancreatic cancer (RPC 42%, 949/2264). The weighted overall recurrence rates were lower among the NAT group, 63.4% vs. 74% (US) (OR 0.67 (CI 0.52–0.87), p = 0.006). The overall weighted locoregional recurrence rate was lower amongst patients who received NAT when compared to US (12% vs 27% OR 0.39 (CI 0.22–0.70), p = 0.004). In BRPC, locoregional recurrence rates improved with NAT (NAT 25.8% US 37.7% OR 0.62 (CI 0.44–0.87), p = 0.007). NAT was associated with a lower weighted liver recurrence rate (NAT 19.4% US 30.1% OR 0.55 (CI 0.34–0.89), p = 0.023). Lung and peritoneal recurrence rates did not differ between NAT and US cohorts (p = 0.705 and p = 0.549 respectively). NAT was associated with a significantly longer weighted mean time to first recurrence 18.8 months compared to US (15.7 months) (OR 0.18 (CI 0.05–0.32), p = 0.015). Conclusion: NAT was associated with lower overall recurrence rate and improved locoregional disease control particularly for those with BRPC. Although the burden of liver metastases was less, there was no overall effect upon distant metastatic disease.

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“…Dabei haben multiple Fernmetastasen sowie isolierte Lebermetastasen eine deutlich schlechtere Prognose und tendieren dazu, früher zu erscheinen als Lokalrezidive oder isolierte Lungenmetastasen. Die adjuvante Chemotherapie verlängert aber dabei deutlich das rezidivfreie Überleben (10,9 versus 7,0 Monate) und ist obligat bei allen neoadjuvant behandelten Patienten [60]. In der Regel wird zwischen Frührezidiv und Spätrezidiv unterschieden, und der beste Cut-off-Wert liegt bei 12 Monaten nach der initialen Operation.…”

Section: Pr a Xisunclassified

Pankreaskarzinom – Chirurgie im Wandel der multimodalen Therapiemöglichkeiten

Belyaev¹,

Uhl²

2019

Allgemein- und Viszeralchirurgie up2date

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Recurrence after neoadjuvant therapy and resection of borderline resectable and locally advanced pancreatic cancer

Cited by 65 publications

References 42 publications

Comparison of Clinical Outcomes of Borderline Resectable Pancreatic Cancer According to the Neoadjuvant Chemo-Regimens: Gemcitabine versus FOLFIRINOX

Comparison of Clinical Outcomes of Borderline Resectable Pancreatic Cancer According to the Neoadjuvant Chemo-Regimens: Gemcitabine versus FOLFIRINOX

Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-Analysis

Pankreaskarzinom – Chirurgie im Wandel der multimodalen Therapiemöglichkeiten

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