Long-term survival benefit of upfront chemotherapy in patients with newly diagnosed borderline resectable pancreatic cancer

Autor: Kevin C. Soares, Daniel A. Laheru, Ana De Jesus-Acosta, Nilofar Azad, Matthew J. Weiss, Lei Zheng, Nita Ahuja, Christopher L. Wolfgang, Yifei Sun, Amol Narang, Valerie Lee, Ross C. Donehower, Dung T. Le, Martin A. Makary, Adrian Murphy, Linda Chen, Avani S. Dholakia, Alex B. Blair, Chiung Yu Huang, Joseph M. Herman, Elliot K. Fishman, Bikram Shrestha, Luis A. Diaz, Tingbo Liang, Victoria M. Kim, Ralph H. Hruban, Lauren M. Rosati, Amy Hacker-Prietz, John L. Cameron, Farzana A. Faisal, Jin He
Rok vydání: 2017
Předmět:
Adult
Male
Cancer Research
medicine.medical_specialty
medicine.medical_treatment
pancreatic cancer
Kaplan-Meier Estimate
03 medical and health sciences
0302 clinical medicine
Borderline resectable
Pancreatic cancer
Antineoplastic Combined Chemotherapy Protocols
Long term survival
Biomarkers
Tumor
Odds Ratio
medicine
Humans
Radiology
Nuclear Medicine and imaging
In patient
neoadjuvant therapy
chemoradiation
Neoadjuvant therapy
Aged
Neoplasm Staging
Proportional Hazards Models
Original Research
resectability
Aged
80 and over
Chemotherapy
business.industry
Clinical Cancer Research
Middle Aged
medicine.disease
Combined Modality Therapy
3. Good health
Surgery
Pancreatic Neoplasms
Survival Rate
Radiation therapy
Treatment Outcome
Oncology
030220 oncology & carcinogenesis
Borderline resectable pancreatic adenocarcinoma
Adenocarcinoma
Female
030211 gastroenterology & hepatology
business
Follow-Up Studies
Zdroj: Cancer Medicine
ISSN: 2045-7634
Popis: The use of neoadjuvant chemotherapy or radiation for borderline resectable pancreatic adenocarcinoma (BL‐PDAC) is increasing. However, the impact of neoadjuvant chemotherapy and radiation therapy on the outcome of BL‐PDAC remains to be elucidated. We performed a retrospective analysis of 93 consecutive patients who were diagnosed with BL‐PDAC and primarily followed at Johns Hopkins Hospital between February 2007 and December 2012. Among 93 patients, 62% received upfront neoadjuvant chemotherapy followed by chemoradiation, whereas 20% received neoadjuvant chemoradiation alone and 15% neoadjuvant chemotherapy alone. Resectability following all neoadjuvant therapy was 44%. Patients who underwent resection with a curative intent had a median overall survival (mOS) of 25.8 months, whereas those who did not undergo surgery had a mOS of 11.9 months. However, resectability and overall survival were not significantly different between the three types of neoadjuvant therapy. Nevertheless, 22% (95% CI, 0.13–0.36) of the 58 patients who received upfront chemotherapy followed by chemoradiation remained alive for a minimum of 48 months compared to none of the 19 patients who received upfront chemoradiation. Among patients who underwent curative surgical resection, 32% (95% CI, 0.19–0.55) of those who received upfront chemotherapy remained disease free at least 48 months following surgical resection, whereas none of the eight patients who received upfront chemoradiation remained disease free beyond 24 months following surgical resection. Neoadjuvant therapy with upfront chemotherapy may result in long‐term survival in a subpopulation of patients with BL‐PDAC.
Databáze: OpenAIRE
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