Neoadjuvant chemotherapy and stereotactic body radiation therapy for borderline resectable pancreas adenocarcinoma: influence of vascular margin status and type of chemotherapy.

Autor:	Palm RF; Department of Radiation Oncology, Moffitt Cancer Center, Tampa FL, USA. Electronic address: Russell.Palm@moffitt.org., Boyer E; University of South Florida School of Medicine, Tampa, FL, USA., Kim DW; Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa FL, USA., Denbo J; Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa FL, USA., Hodul PJ; Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa FL, USA., Malafa M; Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa FL, USA., Fleming JB; Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa FL, USA., Shridhar R; Department of Radiation Oncology, Advent Health, Orlando, FL, USA., Chuong MD; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami FL, USA., Mellon EA; Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA., Frakes JM; Department of Radiation Oncology, Moffitt Cancer Center, Tampa FL, USA., Hoffe SE; Department of Radiation Oncology, Moffitt Cancer Center, Tampa FL, USA.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2023 Sep; Vol. 25 (9), pp. 1110-1120. Date of Electronic Publication: 2023 May 04.
DOI:	10.1016/j.hpb.2023.04.019
Abstrakt:	Background: The influence of chemotherapy type and vascular margin status after sequential chemotherapy and stereotactic body radiation therapy (SBRT) for borderline resectable pancreatic cancer (BRPC) is unknown. Methods: A retrospective review was performed on BRPC patients treated with chemotherapy and 5-fraction SBRT from 2009 to 2021. Surgical outcomes and SBRT-related toxicity were reported. Clinical outcomes were estimated by Kaplan-Meier with log rank comparisons. Results: A total of 303 patients received neoadjuvant chemotherapy and SBRT to a median dose of 40 Gy prescribed to the tumor-vessel interface and median dose of 32.4 Gyto 95% of the gross tumor volume. One hundred and sixty-nine patients (56%) were resected and benefited from improved median OS (41.1 vs 15.5 months, P < 0.001). Close/positive vascular margins were not associated with worse OS or FFLRF. Type of neoadjuvant chemotherapy did not influence OS for resected patients, but FOLFIRINOX was associated with improved median OS in unresected patients (18.2 vs 13.1 months, P = 0.001). Conclusion: For BRPC, the effect of a positive or close vascular margin may be mitigated by neoadjuvant therapy. Shorter duration neoadjuvant chemotherapy as well as the optimal biological effective dose of radiotherapy should be prospectively explored. Competing Interests: Conflict of interest None to declare. (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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