BACKGROUND: Neoadjuvant multi-agent chemotherapy and stereotactic body radiation therapy (SBRT) are utilized to increase margin negative (R0) resection rates in borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) patients. Concerns persist that these neoadjuvant therapies may worsen perioperative morbidities and mortality. METHODS: Upfront resection patients (n=241) underwent resection without neoadjuvant treatment for resectable disease. They were compared to BRPC or LAPC patients (n=61) who underwent resection after chemotherapy and 5 fraction SBRT. Group comparisons were performed by Mann-Whitney U or Fisher's exact test. Overall Survival (OS) was estimated by Kaplan-Meier and compared by log-rank methods. RESULTS: In the neoadjuvant therapy group, there was significantly higher T classification, N classification, and vascular resection/repair rate. Surgical positive margin rate was lower after neoadjuvant therapy (3.3% vs. 16.2%, P=0.006). Post-operative morbidities (39.3% vs. 31.1%, P=0.226) and 90-day mortality (2% vs. 4%, P=0.693) were similar between the groups. Median OS was 33.5 months in the neoadjuvant therapy group compared to 23.1 months in upfront resection patients who received adjuvant treatment (P=0.057). CONCLUSIONS: Patients with BRPC or LAPC and sufficient response to neoadjuvant multi-agent chemotherapy and SBRT have similar or improved peri-operative and long-term survival outcomes compared to upfront resection patients.
BACKGROUND: Neoadjuvant multi-agent chemotherapy and stereotactic body radiation therapy (SBRT) are utilized to increase margin negative (R0) resection rates in borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) patients. Concerns persist that these neoadjuvant therapies may worsen perioperative morbidities and mortality. METHODS: Upfront resection patients (n=241) underwent resection without neoadjuvant treatment for resectable disease. They were compared to BRPC or LAPC patients (n=61) who underwent resection after chemotherapy and 5 fraction SBRT. Group comparisons were performed by Mann-Whitney U or Fisher's exact test. Overall Survival (OS) was estimated by Kaplan-Meier and compared by log-rank methods. RESULTS: In the neoadjuvant therapy group, there was significantly higher T classification, N classification, and vascular resection/repair rate. Surgical positive margin rate was lower after neoadjuvant therapy (3.3% vs. 16.2%, P=0.006). Post-operative morbidities (39.3% vs. 31.1%, P=0.226) and 90-day mortality (2% vs. 4%, P=0.693) were similar between the groups. Median OS was 33.5 months in the neoadjuvant therapy group compared to 23.1 months in upfront resection patients who received adjuvant treatment (P=0.057). CONCLUSIONS:Patients with BRPC or LAPC and sufficient response to neoadjuvant multi-agent chemotherapy and SBRT have similar or improved peri-operative and long-term survival outcomes compared to upfront resection patients.
Authors: Jeannelyn S Estrella; Asif Rashid; Jason B Fleming; Matthew H Katz; Jeffrey E Lee; Robert A Wolf; Gauri R Varadhachary; Peter W T Pisters; Eddie K Abdalla; Jean-Nicolas Vauthey; Hua Wang; Henry F Gomez; Douglas B Evans; James L Abbruzzese; Huamin Wang Journal: Cancer Date: 2011-07-06 Impact factor: 6.860
Authors: Morten Hoyer; Henrik Roed; Lisa Sengelov; Anders Traberg; Lars Ohlhuis; Jorgen Pedersen; Hanne Nellemann; Anne Kiil Berthelsen; Frey Eberholst; Svend Aage Engelholm; Hans von der Maase Journal: Radiother Oncol Date: 2005-07 Impact factor: 6.280
Authors: Lola Rahib; Benjamin D Smith; Rhonda Aizenberg; Allison B Rosenzweig; Julie M Fleshman; Lynn M Matrisian Journal: Cancer Res Date: 2014-06-01 Impact factor: 12.701
Authors: David Yu Greenblatt; Kaitlyn J Kelly; Victoria Rajamanickam; Yin Wan; Todd Hanson; Robert Rettammel; Emily R Winslow; Clifford S Cho; Sharon M Weber Journal: Ann Surg Oncol Date: 2011-02-20 Impact factor: 5.344
Authors: R R White; H I Hurwitz; M A Morse; C Lee; M S Anscher; E K Paulson; M R Gottfried; J Baillie; M S Branch; P S Jowell; K M McGrath; B M Clary; T N Pappas; D S Tyler Journal: Ann Surg Oncol Date: 2001-12 Impact factor: 5.344
Authors: Karl Y Bilimoria; Mark S Talamonti; Stephen F Sener; Malcolm M Bilimoria; Andrew K Stewart; David P Winchester; Clifford Y Ko; David J Bentrem Journal: J Am Coll Surg Date: 2008-06-30 Impact factor: 6.113
Authors: Michael D Chuong; Gregory M Springett; Jessica M Freilich; Catherine K Park; Jill M Weber; Eric A Mellon; Pamela J Hodul; Mokenge P Malafa; Kenneth L Meredith; Sarah E Hoffe; Ravi Shridhar Journal: Int J Radiat Oncol Biol Phys Date: 2013-04-05 Impact factor: 7.038
Authors: Malolan S Rajagopalan; Dwight E Heron; Rodney E Wegner; Herbert J Zeh; Nathan Bahary; Alyssa M Krasinskas; Barry Lembersky; Randall Brand; A James Moser; Annette E Quinn; Steven A Burton Journal: Radiat Oncol Date: 2013-10-31 Impact factor: 3.481
Authors: Francesco D'Angelo; Laura Antolino; Alessio Farcomeni; Dario Sirimarco; Andrea Kazemi Nava; Martina De Siena; Niccolò Petrucciani; Giuseppe Nigri; Stefano Valabrega; Paolo Aurello; Giovanni Ramacciato Journal: Med Oncol Date: 2017-04-08 Impact factor: 3.064
Authors: William H Jin; Eric A Mellon; Jessica M Frakes; Gilbert Z Murimwa; Pamela J Hodul; Jose M Pimiento; Mokenge P Malafa; Sarah E Hoffe Journal: J Gastrointest Oncol Date: 2018-02
Authors: Asmita Chopra; Jacob C Hodges; Adam Olson; Steve Burton; Susannah G Ellsworth; Nathan Bahary; Aatur D Singhi; Brian A Boone; Joal D Beane; David Bartlett; Kenneth K Lee; Melissa E Hogg; Michael T Lotze; Alessandro Paniccia; Herbert Zeh; Amer H Zureikat Journal: Ann Surg Oncol Date: 2020-11-24 Impact factor: 4.339
Authors: Alex B Blair; Lauren M Rosati; Neda Rezaee; Georgios Gemenetzis; Lei Zheng; Ralph H Hruban; John L Cameron; Matthew J Weiss; Christopher L Wolfgang; Joseph M Herman; Jin He Journal: Surgery Date: 2018-03-12 Impact factor: 4.348