M Itchins1, J Arena2, C B Nahm3, J Rabindran3, S Kim4, E Gibbs5, S Bergamin2, T C Chua4, A J Gill6, R Maher7, C Diakos8, M Wong9, A Mittal3, G Hruby10, A Kneebone10, N Pavlakis8, J Samra3, S Clarke8. 1. Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia. Electronic address: mitchins@gmail.com. 2. Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia. 3. Upper GI Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia. 4. Upper GI Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia. 5. National Health and Medical Research Council Clinical Trial Centre (NHMRC CTC), The University of Sydney, Australia. 6. Sydney Medical School (Northern), The University of Sydney, Australia; Cancer Diagnosis and Pathology, Kolling Institute, Royal North Shore Hospital, Sydney, Australia. 7. Department of Radiology, Royal North Shore Hospital, Australia. 8. Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia; Northern Cancer Institute, Sydney, NSW, Australia. 9. Department of Medical Oncology, Gosford Hospital, New South Wales, Australia. 10. Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia.
Abstract
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease. Neoadjuvant therapy (NA) with chemotherapy (NAC) and radiotherapy (RT) prior to surgery provides promise. In the absence of prospective data, well annotated clinical data from high-volume units may provide pilot data for randomised trials. METHODS: Medical records from a tertiary hospital in Sydney, Australia, were analysed to identify all patients with resectable or borderline resectable PDAC. Data regarding treatment, toxicity and survival were collected. RESULTS: Between January 1 2010 and April 1 2016, 220 sequential patients were treated: 87 with NA and 133 with upfront operation (UO). Forty-three NA patients (52%) and 5 UO patients (4%) were borderline resectable at diagnosis. Twenty-four borderline patients received NA RT, 22 sequential to NAC. The median overall survival (OS) in the NA group was 25.9 months (mo); 95% CI (21.1-43.0 mo) compared to 26.9 mo (19.7, 32.7) in the UO; HR 0.89; log-ranked p-value = 0.58. Sixty-nine NA patients (79%) were resected, mOS was 29.2 mo (22.27, not reached (NR)). Twenty-two NA (31%) versus 22 UO (17%) were node negative at operation (N0). In those managed with NAC/RT the mOS was 29.0 mo (17.3, NR). There were no post-operative deaths with NA within 90-days and three in the UO arm. DISCUSSION: This is a hypothesis generating retrospective review of a selected real-world population in a high-throughput unit. Treatment with NA was well tolerated. The long observed survival in this group may be explained by lymph node sterilisation by NA, and the achievement of R0 resection in a greater proportion of patients.
BACKGROUND:Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease. Neoadjuvant therapy (NA) with chemotherapy (NAC) and radiotherapy (RT) prior to surgery provides promise. In the absence of prospective data, well annotated clinical data from high-volume units may provide pilot data for randomised trials. METHODS: Medical records from a tertiary hospital in Sydney, Australia, were analysed to identify all patients with resectable or borderline resectable PDAC. Data regarding treatment, toxicity and survival were collected. RESULTS: Between January 1 2010 and April 1 2016, 220 sequential patients were treated: 87 with NA and 133 with upfront operation (UO). Forty-three NA patients (52%) and 5 UOpatients (4%) were borderline resectable at diagnosis. Twenty-four borderline patients received NA RT, 22 sequential to NAC. The median overall survival (OS) in the NA group was 25.9 months (mo); 95% CI (21.1-43.0 mo) compared to 26.9 mo (19.7, 32.7) in the UO; HR 0.89; log-ranked p-value = 0.58. Sixty-nine NA patients (79%) were resected, mOS was 29.2 mo (22.27, not reached (NR)). Twenty-two NA (31%) versus 22 UO (17%) were node negative at operation (N0). In those managed with NAC/RT the mOS was 29.0 mo (17.3, NR). There were no post-operative deaths with NA within 90-days and three in the UO arm. DISCUSSION: This is a hypothesis generating retrospective review of a selected real-world population in a high-throughput unit. Treatment with NA was well tolerated. The long observed survival in this group may be explained by lymph node sterilisation by NA, and the achievement of R0 resection in a greater proportion of patients.
Authors: Kim C Honselmann; Ilaria Pergolini; Carlos Fernandez-Del Castillo; Vikram Deshpande; David Ting; Martin S Taylor; Louisa Bolm; Motaz Qadan; Ulrich Wellner; Marta Sandini; Dirk Bausch; Andrew L Warshaw; Keith D Lillemoe; Tobias Keck; Cristina R Ferrone Journal: Ann Surg Date: 2019-01-18 Impact factor: 12.969
Authors: Quisette P Janssen; Stefan Buettner; Mustafa Suker; Berend R Beumer; Pietro Addeo; Philippe Bachellier; Nathan Bahary; Tanios Bekaii-Saab; Maria A Bali; Marc G Besselink; Brian A Boone; Ian Chau; Stephen Clarke; Mary Dillhoff; Bassel F El-Rayes; Jessica M Frakes; Derek Grose; Peter J Hosein; Nigel B Jamieson; Ammar A Javed; Khurum Khan; Kyu-Pyo Kim; Song Cheol Kim; Sunhee S Kim; Andrew H Ko; Jill Lacy; Georgios A Margonis; Martin D McCarter; Colin J McKay; Eric A Mellon; Sing Yu Moorcraft; Ken-Ichi Okada; Alessandro Paniccia; Parag J Parikh; Niek A Peters; Hans Rabl; Jaswinder Samra; Christoph Tinchon; Geertjan van Tienhoven; Eran van Veldhuisen; Andrea Wang-Gillam; Matthew J Weiss; Johanna W Wilmink; Hiroki Yamaue; Marjolein Y V Homs; Casper H J van Eijck; Matthew H G Katz; Bas Groot Koerkamp Journal: J Natl Cancer Inst Date: 2019-08-01 Impact factor: 13.506
Authors: Kim C Honselmann; Ilaria Pergolini; Carlos Fernandez-Del Castillo; Vikram Deshpande; David Ting; Martin S Taylor; Louisa Bolm; Motaz Qadan; Ulrich Wellner; Marta Sandini; Dirk Bausch; Andrew L Warshaw; Keith D Lillemoe; Tobias Keck; Cristina R Ferrone Journal: Ann Surg Date: 2020-08 Impact factor: 13.787
Authors: Sumit Sahni; Christopher Nahm; Christoph Krisp; Mark P Molloy; Shreya Mehta; Sarah Maloney; Malinda Itchins; Nick Pavlakis; Stephen Clarke; David Chan; Anthony J Gill; Viive M Howell; Jaswinder Samra; Anubhav Mittal Journal: Front Oncol Date: 2020-03-04 Impact factor: 6.244
Authors: Sheila D Rustgi; Haley M Zylberberg; Sunil Amin; Anne Aronson; Satish Nagula; Christopher J DiMaio; Nikhil A Kumta; Aimee L Lucas Journal: Endosc Int Open Date: 2022-01-14