Current Status and Long-term Outcome of Neoadjuvant Chemoradiotherapy for Resectable Pancreatic Cancer

Abstract Background Retroperitoneal (RPS) and intra-abdominal sarcomas (IAS) are associated with poor local and abdominal tumor control. Yet, the benefit of preoperative radio- or chemotherapy alone for these entities currently is unclear. Moreover, as intermediate- and high-grade sarcomas have a tendency for early metastasis, exploration of neoadjuvant strategies is of high importance. This analysis reports the results of our 20-year single-institution experience with preoperative neoadjuvant concurrent chemoradiation.Methods From 2000-2019, 27 patients with intermediate- or high-grade RPS or IAS (12 dedifferentiated liposarcoma, 10 leiomyosarcoma, 5 others) were treated with radiotherapy (median dose: 50.4 Gy; range 45-75 Gy) and two cycles of chemotherapy (doxorubicin 50mg/m² BSA/d3 q28 and ifosfamide 1.5g/m2 BSA/d1-5 q28) in neoadjuvant intention. Chemotherapy consisted of doxorubicin alone in two cases and ifosfamide alone in one case. Fifteen patients (56%) received deep regional hyperthermia additionally.Results The median follow-up time was 53 months (± 56.7 months). 92% of patients received two cycles of chemotherapy as planned and 92% underwent surgery. At 5 and 10 years, abdominal-recurrence-free-survival was 74.6% (± 10.1%) and 66.3% (± 11.9%), distant-metastasis-free-survival was 67.2% (± 9.7%) and 59.7% (± 11.1%), and overall-survival was 60.3% (± 10.5%) and 60.3% (± 10.5%), respectively. CTC grade III and IV toxicities were leukocytopenia (85%), thrombocytopenia (33%) and anemia (11%). There were no treatment-related deaths.Conclusions Neoadjuvant chemoradiotherapy with and without hyperthermia for retroperitoneal and intra-abdominal sarcoma is feasible and provided high local control of intermediate - and high-grade sarcoma.

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Locally Advanced Pancreatic Head Cancer: Margin-Positive Resection or Bypass?

ISRN Surgery ◽

10.5402/2012/513241 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Ulrich Friedrich Wellner ◽

Frank Makowiec ◽

Dirk Bausch ◽

Jens Höppner ◽

Olivia Sick ◽

...

Keyword(s):

Pancreatic Cancer ◽

Locally Advanced ◽

Pancreatic Head ◽

Resection Margins ◽

Term Outcome ◽

Term Survival ◽

Long Term Outcome ◽

Pancreatic Head Cancer ◽

Margin Positive

Pancreatic cancer is a highly aggressive disease with poor survival. The only effective therapy offering long-term survival is complete surgical resection. In the setting of nonmetastatic disease, locally advanced tumors constitute a technical challenge to the surgeon and may result in margin-positive resection margins. Few studies have evaluated the implications of the latter in depth. The aim of this study was to compare the margin-positive situation to palliative bypass procedures and margin-negative resections in terms of perioperative and long-term outcome. By retrospective analysis of prospectively maintained data from 360 patients operated for pancreatic cancer at our institution, we provide evidence that margin-positive resection still yields a significant survival benefit over palliative bypass procedures. At the same time, perioperative severe morbidity and mortality are not significantly increased. Our observations suggest that pancreatic cancer should be resected whenever technically feasible, including, cases of locally advanced disease.

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Long-term outcome in patients with a pathological complete response after neoadjuvant chemoradiation for pancreatic cancer

HPB ◽

10.1016/j.hpb.2016.02.268 ◽

2016 ◽

Vol 18 ◽

pp. e115

Author(s):

J. He ◽

L. Rosati ◽

A. Blair ◽

A. Javed ◽

T. Pawlik ◽

...

Keyword(s):

Pancreatic Cancer ◽

Pathological Complete Response ◽

Complete Response ◽

Neoadjuvant Chemoradiation ◽

Term Outcome ◽

Long Term Outcome

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Long-Term Outcome Of Conversion Surgery For Initially Unresectable Pancreatic Cancer: A Single Institutional Experience

HPB ◽

10.1016/j.hpb.2019.10.1721 ◽

2019 ◽

Vol 21 ◽

pp. S262-S263

Author(s):

Keita Wada ◽

Keiji Sano ◽

Fumihiko Miura ◽

Makoto SHibuya ◽

Kunihiko Takahashi ◽

...

Keyword(s):

Pancreatic Cancer ◽

Unresectable Pancreatic Cancer ◽

Conversion Surgery ◽

Term Outcome ◽

Long Term Outcome ◽

Institutional Experience

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Phase I/II trial of neoadjuvant chemoradiotherapy with 5-FU, cisplatin, mitomycin C, and heparin for borderline resectable pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.315 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 315-315

Author(s):

Taizo Hibi ◽

Minoru Kitago ◽

Koichi Aiura ◽

Minoru Tanabe ◽

Osamu Itano ◽

...

Keyword(s):

Pancreatic Cancer ◽

Mitomycin C ◽

Curative Resection ◽

Neoadjuvant Chemoradiotherapy ◽

Advanced Pancreatic Cancer ◽

Resectable Pancreatic Cancer ◽

Borderline Resectable ◽

Borderline Resectable Pancreatic Cancer ◽

Disease Free

315 Background: Because of the high incidence of local recurrence and liver metastasis, long-term outcomes of patients following resection of advanced pancreatic cancer are extremely poor. Facilitation of curative resection and prevention of micrometastasis are the goals of neoadjuvant therapy. We evaluated the feasibility and efficacy of our neoadjuvant chemoradiotherapy (NACRT) protocol for borderline resectable pancreatic cancer patients. Methods: During the period between 2003 and 2011, 24 patients with borderline resectable pancreatic cancers underwent NACRT comprising 5-FU (300 mg/body/day, day 1−5/week for 4 weeks), cisplatin (10mg/body day2, 9, 16, 23), mitomycin C (4mg/body/day, day 1, 8, 15, and 22), heparin (6000 IU/body/day for 4 weeks), and radiation (2 Gy/day, day 1−5/week for 4 weeks, total 40 Gy). They were reevaluated for resectability after therapy. Primary endpoints were toxicity and overall patient and disease-free survivals. Secondary endpoint was the ratio of microscopically margin negative resection. Results: All 24 patients completedNACRT. Grade 3−4 hematological adverse events were observed in 9 (38%) patients but none developed severe gastrointestinal toxicity. In 7 (29%) patients, restaging revealed distant metastasis or local disease progression not amenable to curative resection. The remaining 17 patients (71%) underwent surgery (pancreatoduodenectomy, 13 and distal pancreatectomy, 4) with zero 30-day postoperative or in-hospital mortality. The 5-year overall all patient and disease-free survival rates after pancreatectomy were 52.6% and 36.3%, respectively. Postoperative histopathological evaluation demonstrated a marked degenerative change in the specimen, achieving negative surgical margins in 15/17 (88%) patients and pathological complete response in the remaining 2 (12%) patients. Conclusions: Our NACRT protocol is feasible with a low toxicity profile and an excellent curative resection rate in the treatment of borderline resectable pancreatic cancer. It is a promising regimen associated with improved long-term prognoses than historical controls.

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Perioperative and long-term impact of neoadjuvant chemoradiotherapy using full-dose gemcitabine and concurrent radiation for resectable pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.367 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 367-367

Author(s):

Minako Nagai ◽

Takahiro Akahori ◽

Satoshi Nishiwada ◽

Kenji Nakagawa ◽

Kota Nakamura ◽

...

Keyword(s):

Pancreatic Cancer ◽

Neoadjuvant Chemoradiotherapy ◽

Control Group ◽

Poor Performance Status ◽

Resectable Pancreatic Cancer ◽

Borderline Resectable ◽

Full Dose ◽

Venous Involvement ◽

The Impact

367 Background: Although much attention has been paid to neoadjuvat treatment for pancreatic cancer (PC), its efficacy remains to be established. In this study, we have retrospectively evaluated the impact of neoadjuvant chemoradiotherapy (NACRT) on perioperative and long-term clinical outcome in PC. Methods: One hundred sixty patients who preoperatively received full-dose gemcitabine (1000 mg/m2) with concurrent radiation of 54 Gy between 2006 and 2016 were analyzed. One hundred thirty patients who underwent upfront surgery were served as control. Results: Among the 160 patients treated with NACRT, 153 patients (96%) completed the protocol treatment. The reasons of failure to complete NACRT were drug-induced pneumonia, acute mucosal injury, severe cholangitis and poor performance status (PS). Furthermore 21 (13%) couldn’t undergo pancreatic resection after NACRT because of distant metastasis in 9 patients, tumor progression in 7 and poor PS in 5. The rate of pancreatic fistula was lower and hospital stay was shorter in the NACRT group compared to the control group (P = 0.033, P = 0.002). Furthermore, the rate of lymph node metastasis, R0 resection and pathological stage were favorable in the NACRT group (P < 0.0001, P = 0.006, P < 0.0001). The completion rate of adjuvant chemotherapy was also higher in the NACRT group (P = 0.015). Importantly, patients treated with NACRT had a better prognosis than those without (median survival time: 60.2 vs. 28.5M, P = 0.008). In addition, according to tumor resectability status, patients were classified as R (resectable), BR-P (borderline resectable with venous involvement) and BR-A (borderline resectable with arterial involvement) groups. As a result, patients treated with NACRT had a better prognosis than those without in the R and BR-P groups (58.6 vs. 34.2M, P = 0.013, 62.4 vs. 18.8M, P = 0.015), while NACRT had no significant impact on prognosis in the BR-A group. Conclusions: Neoadjuvant chemoradiotherapy may have a variety of favorable impact in pancreatic cancer treatment. Furthermore, NACRT may improve the prognosis especially in resectable and borderline resectable pancreatic cancer with venous involvement.

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Foetal therapy: what works? Closed interatrial septum

Cardiology in the Young ◽

10.1017/s104795111400122x ◽

2014 ◽

Vol 24 (S2) ◽

pp. 47-54 ◽

Cited By ~ 9

Author(s):

Ulrike Herberg ◽

Christoph Berg ◽

Annegret Geipel ◽

Ulrich Gembruch ◽

Johannes Breuer

Keyword(s):

Pulmonary Hypertension ◽

Interatrial Septum ◽

Current Status ◽

Long Term Outcomes ◽

Term Outcome ◽

Long Term Outcome ◽

Short And Long Term ◽

Left Heart Syndrome ◽

Foetal Diagnosis

AbstractHypoplastic left-heart syndrome and critical aortic stenosis with severely restricted or intact foramen ovale are associated with high neonatal mortality and poor long-term outcome. Despite accurate foetal diagnosis and successful postnatal catheter-based and surgical intervention, the 1-month survival rate is about 33%. Changes in pulmonary vascular architecture resulting in pulmonary hypertension result in important long-term morbidity. Prenatal relief of left atrial and pulmonary hypertension may promote normal pulmonary vascular and parenchymal development and improve short- and long-term outcomes. Foetal atrial balloon septostomy, laser perforation, and stenting of the foetal interatrial septum are the current options for foetal therapy. This paper provides an overview of foetal diagnosis, selection of patients for foetal intervention, and interventional techniques, and also reviews the current status of foetal and postnatal outcomes after intrauterine intervention.

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