Favorable perioperative outcomes after resection of borderline resectable pancreatic cancer treated with neoadjuvant stereotactic radiation and chemotherapy compared with upfront pancreatectomy for resectable cancer
Autor: | Jessica M. Frakes, Pamela J. Hodul, Ravi Shridhar, Tobin Strom, Eric A. Mellon, Gregory M. Springett, Mokenge P. Malafa, Michael D. Chuong, Sarah E. Hoffe |
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Rok vydání: | 2016 |
Předmět: |
Chemotherapy
medicine.medical_specialty business.industry medicine.medical_treatment Gastroenterology Cancer Perioperative medicine.disease Surgery Radiation therapy 03 medical and health sciences Exact test 0302 clinical medicine Oncology 030220 oncology & carcinogenesis Pancreatic cancer Pancreatectomy medicine Original Article 030211 gastroenterology & hepatology business Neoadjuvant therapy |
Zdroj: | Journal of Gastrointestinal Oncology. 7:547-555 |
ISSN: | 2219-679X 2078-6891 |
Popis: | 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. |
Databáze: | OpenAIRE |
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