R0 resection following chemo (radio)therapy improves survival of primary inoperable pancreatic cancer patients. Interim results of the German randomized CONKO-007± trial
| Autor: | Uwe A. Wittel, A Pirkl, Werner Hohenberger, Stefan Boeck, Ulf P. Neumann, Helmut Oettle, Anke Reinacher-Schick, Roland S. Croner, L. Jacobasch, Sabine Semrau, Henriette Golcher, Ludwig Keilholz, Rainer Fietkau, Robert Grützmann, Michael Ghadimi, Waldemar Uhl, Sandra Rutzner, Werner Adler, Wolf O. Bechstein, D. Imhoff, Dorota Lubgan |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
FOLFIRINOX medicine.medical_treatment Prospective randomized multicenter trial law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Pancreatic cancer medicine Humans Radiology Nuclear Medicine and imaging ddc:610 030212 general & internal medicine Chemotherapy business.industry Induction chemotherapy Chemoradiotherapy medicine.disease Interim analysis Gemcitabine Surgery Neoadjuvant chemoradiotherapy Pancreatic Neoplasms Radiation therapy Tumor resectability Oncology 030220 oncology & carcinogenesis Original Article business Pancreatic adenocarcinoma medicine.drug |
| Zdroj: | Strahlentherapie Und Onkologie |
| ISSN: | 1439-099X 0179-7158 |
| Popis: | Purpose Chemotherapy with or without radiotherapy is the standard in patients with initially nonmetastatic unresectable pancreatic cancer. Additional surgery is in discussion. The CONKO-007 multicenter randomized trial examines the value of radiotherapy. Our interim analysis showed a significant effect of surgery, which may be relevant to clinical practice. Methods One hundred eighty patients received induction chemotherapy (gemcitabine or FOLFIRINOX). Patients without tumor progression were randomized to either chemotherapy alone or to concurrent chemoradiotherapy. At the end of therapy, a panel of five independent pancreatic surgeons judged the resectability of the tumor. Results Following induction chemotherapy, 126/180 patients (70.0%) were randomized to further treatment. Following study treatment, 36/126 patients (28.5%) underwent surgery; (R0: 25/126 [19.8%]; R1/R2/Rx [n = 11/126; 6.1%]). Disease-free survival (DFS) and overall survival (OS) were significantly better for patients with R0 resected tumors (median DFS and OS: 16.6 months and 26.5 months, respectively) than for nonoperated patients (median DFS and OS: 11.9 months and 16.5 months, respectively; p = 0.003). In the 25 patients with R0 resected tumors before treatment, only 6/113 (5.3%) of the recommendations of the panel surgeons recommended R0 resectability, compared with 17/48 (35.4%) after treatment (p Conclusion Tumor resectability of pancreatic cancer staged as unresectable at primary diagnosis should be reassessed after neoadjuvant treatment. The patient should undergo surgery if a resectability is reached, as this significantly improves their prognosis. |
| Databáze: | OpenAIRE |
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