Survival of patients with borderline resectable pancreatic cancer who received neoadjuvant therapy and surgery
| Autor: | William A. Hall, Paul S. Ritch, Catherine Hagen, Callisia N. Clarke, Susan Tsai, Chad A. Barnes, Parag Tolat, Kulwinder S. Dua, Kathleen K. Christians, Ben George, Douglas B. Evans, Beth Erickson, Mohammed Aldakkak, Mariana I. Chavez |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Multimodality Therapy Comorbidity Kaplan-Meier Estimate 030230 surgery 03 medical and health sciences 0302 clinical medicine Pancreatectomy Pancreatic cancer Antineoplastic Combined Chemotherapy Protocols medicine Combined Modality Therapy Humans Neoadjuvant therapy Aged Neoplasm Staging Proportional Hazards Models Retrospective Studies Aged 80 and over Chemotherapy business.industry Retrospective cohort study Middle Aged Pancreaticoduodenectomy medicine.disease Prognosis Neoadjuvant Therapy Surgery Clinical trial Pancreatic Neoplasms Treatment Outcome 030220 oncology & carcinogenesis Female business |
| Zdroj: | Surgery. 166(3) |
| ISSN: | 1532-7361 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect