Chad A Barnes1, Mariana I Chavez1, Susan Tsai1, Mohammed Aldakkak1, Ben George2, Paul S Ritch2, Kulwinder Dua3, Callisia N Clarke1, Parag Tolat4, Catherine Hagen5, William A Hall6, Beth A Erickson6, Douglas B Evans1, Kathleen K Christians7. 1. Pancreatic Cancer Program, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. 2. Pancreatic Cancer Program, Department of Medicine, Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI. 3. Pancreatic Cancer Program, Department of Medicine, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, WI. 4. Pancreatic Cancer Program, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI. 5. Pancreatic Cancer Program, Department of Pathology, Medical College of Wisconsin, Milwaukee, WI. 6. Pancreatic Cancer Program, Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI. 7. Pancreatic Cancer Program, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. Electronic address: kchristi@mcw.edu.
Abstract
BACKGROUND: It is difficult to successfully deliver multimodality therapy to patients with operable pancreatic cancer. Data on the natural history of such efforts are necessary for physicians to guide shared decision-making with patients and families. We report the survival of consecutive patients with borderline resectable pancreatic cancer who received neoadjuvant therapy before surgery. METHODS: Data regarding demographics, neoadjuvant therapy, surgery, pathology, and survival duration were abstracted on consecutive patients with borderline resectable pancreatic cancer diagnosed between 2009 and 2017 and not treated on available clinical trials. Borderline resectable pancreatic cancer was defined based on ≥1 of the following: local tumor anatomy, pretreatment serum carbohydrate antigen 19-9 >2,000 U/mL, and the presence of radiographic lesions indeterminate for metastases. RESULTS: Neoadjuvant therapy was delivered to 185 patients with borderline resectable pancreatic cancer who were not enrolled in competing clinical trials; 13 (7%) patients received chemoradiation, 12 (7%) received chemotherapy, and 160 (86%) received both. Of the 185 patients, 115 (62%) completed all intended neoadjuvant therapy and surgery; 81 (70%) of 115 underwent pancreaticoduodenectomy; and vascular reconstruction was performed in 51 (44%). A margin negative resection was achieved in 111 (97%) of 115 patients, and 83 (72%) were node negative. Median overall survival for all 185 patients was 20 months; 31 months for the 115 patients who completed all neoadjuvant therapy and surgery as compared to 13 months for the 70 patients who were not resected (P < .0001). CONCLUSION: After neoadjuvant therapy, surgical resection was performed in 62% of patients with borderline resectable pancreatic cancer. Those who normalized preoperative serum carbohydrate antigen 19-9 and had node negative pathology achieved the longest survival. To further improve median survival for all patients, we are incorporating adaptive approaches to neoadjuvant therapy sequencing based on objective assessments of response.
BACKGROUND: It is difficult to successfully deliver multimodality therapy to patients with operable pancreatic cancer. Data on the natural history of such efforts are necessary for physicians to guide shared decision-making with patients and families. We report the survival of consecutive patients with borderline resectable pancreatic cancer who received neoadjuvant therapy before surgery. METHODS: Data regarding demographics, neoadjuvant therapy, surgery, pathology, and survival duration were abstracted on consecutive patients with borderline resectable pancreatic cancer diagnosed between 2009 and 2017 and not treated on available clinical trials. Borderline resectable pancreatic cancer was defined based on ≥1 of the following: local tumor anatomy, pretreatment serum carbohydrate antigen 19-9 >2,000 U/mL, and the presence of radiographic lesions indeterminate for metastases. RESULTS: Neoadjuvant therapy was delivered to 185 patients with borderline resectable pancreatic cancer who were not enrolled in competing clinical trials; 13 (7%) patients received chemoradiation, 12 (7%) received chemotherapy, and 160 (86%) received both. Of the 185 patients, 115 (62%) completed all intended neoadjuvant therapy and surgery; 81 (70%) of 115 underwent pancreaticoduodenectomy; and vascular reconstruction was performed in 51 (44%). A margin negative resection was achieved in 111 (97%) of 115 patients, and 83 (72%) were node negative. Median overall survival for all 185 patients was 20 months; 31 months for the 115 patients who completed all neoadjuvant therapy and surgery as compared to 13 months for the 70 patients who were not resected (P < .0001). CONCLUSION: After neoadjuvant therapy, surgical resection was performed in 62% of patients with borderline resectable pancreatic cancer. Those who normalized preoperative serum carbohydrate antigen 19-9 and had node negative pathology achieved the longest survival. To further improve median survival for all patients, we are incorporating adaptive approaches to neoadjuvant therapy sequencing based on objective assessments of response.
Authors: Michael T Zimmermann; Angela J Mathison; Tim Stodola; Douglas B Evans; Jenica L Abrudan; Wendy Demos; Michael Tschannen; Mohammed Aldakkak; Jennifer Geurts; Gwen Lomberk; Susan Tsai; Raul Urrutia Journal: Front Oncol Date: 2021-03-05 Impact factor: 6.244
Authors: Jin Ho Choi; Min Kyu Kim; Sang Hyub Lee; Jin Woo Park; Namyoung Park; In Rae Cho; Ji Kon Ryu; Yong-Tae Kim; Jin-Young Jang; Wooil Kwon; Hongbeom Kim; Woo Hyun Paik Journal: Front Oncol Date: 2022-09-20 Impact factor: 5.738