Clinical outcomes in borderline resectable pancreatic cancer: A cohort study.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 494-494
Author(s):  
Davendra Sohal ◽  
Mohammad Altujjar ◽  
Katherine Tullio ◽  
Mohamed Abazeed ◽  
Robert James Pelley ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cohort Study ◽  
Surgical Resection ◽  
Cleveland Clinic ◽  
Pancreatic Head ◽  
Vascular Involvement ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Cross Sectional ◽  
Borderline Resectable Pancreatic Cancer

494 Background: The management of borderline resectable pancreatic cancer (BRPC) remains unsettled and the predictors of outcome are uncertain. We evaluated the role of neoadjuvant therapy (nRx) and outcomes in patients with BRPC. Methods: We conducted a retrospective cohort study of consecutive patients with BRPC who received nRx and were followed at the Cleveland Clinic. A histopathologic diagnosis of pancreatic carcinoma was required. Tumor anatomy was assessed by contrast-enhanced cross-sectional imaging (CT or MRI), and BRPC was defined as a tumor-vessel wall interface involving one or more of: celiac artery, superior mesenteric artery, common hepatic artery, main portal vein, superior mesenteric vein; making margin-negative resection unlikely. Baseline laparoscopy was performed to rule out occult metastatic disease. Chemotherapy (CT), radiation (RT), surgery details, and pathologic and survival outcomes were evaluated. Hazard ratios (HR) with 95% confidence intervals (CI) and 2-sided p-values are presented. Results: The study population comprised 79 patients from 2009 to 2014. Median age was 64 years; 52% were male; 85% were Caucasian. Pancreatic head/neck were the primary site in 81%; body/tail in 19%. Vascular involvement included arterial in 32 (41%), and venous in 65 (82%) patients. nRx included RT in all patients; 77 (97%) received CT; gemcitabine (n = 50, 63%) was the most common agent. After CT/RT, 36 (46%) patients had unresectable/inoperable disease: 29 (37%) for anatomic reasons, 4 (5%) for physiologic reasons, and 3 (4%) for both. Surgical resection was performed in 43 (54%) patients; 38 (88%) had negative margins; 30 (70%) had negative nodes; 32 (74%) received adjuvant CT. There were no statistically significant predictors of resection. After median follow-up of 27 mths, there have been 45 deaths (57%); median overall survival (mOS) is 23.5 mths (95% CI: 16-28 mths). Only cancer resection was associated with survival (mOS, resected: not reached; mOS, not resected: 12.8 mths; HR: 0.30, 95% CI: 0.16-0.56, p = 0.0002). Conclusions: Surgical resection, if feasible, of BRPC is associated with improved OS. Strategies to improve the odds of resection should be evaluated in prospective studies.

Outcomes of patients with borderline-resectable pancreatic cancer treated with FOLFIRINOX versus gemcitabine plus nab-paclitaxel.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 299-299
Author(s):  
Shaina D'Lee Templeton ◽  
Michael Moser ◽  
Haji I. Chalchal ◽  
John Shaw ◽  
Yigang Luo ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Performance Status ◽  
Advanced Pancreatic Cancer ◽  
Pancreatic Head ◽  
Progression Free Survival ◽  
Incomplete Resection ◽  
Resectable Pancreatic Cancer ◽  
Curative Surgery ◽  
Borderline Resectable ◽  
Borderline Resectable Pancreatic Cancer

299 Background: Pancreatic cancer is a major cause of cancer-related death. Less than 20% of patients have resectable disease at diagnosis. Patients with borderline-resectable pancreatic cancer (BRPC) are at high risk of incomplete resection with upfront surgery. Currently there is no standard induction chemotherapy regimen exists for BRPC. Both FOLFIRINOX (5-FU, irinotecan, oxaliplatin) and gemcitabine/nab-paclitaxel (GnP) have shown better efficacy than gemcitabine in advanced pancreatic cancer. The current study aims to assess outcomes of real-world patients with BRCP who received induction FOLFIRINOX or GnP. Methods: In this population-based multicenter retrospective cohort study patients with biopsy proven BRPC as defined by the pancreatic surgical team diagnosed from 2011-2017, in the province of Saskatchewan, Canada, who received FOLFIRINOX or GnP were assessed. Kaplan Meier methods and log rank tests were performed for survival analyses. Results: Of 161 patients with pancreatic cancer who received FOLFIRINOX or GnP during the study period, 20 eligible patients with BRPC, with median age of 65 yrs (54-79) and M:F 14:6, were identified. 85% had pancreatic head tumours with a median CA19-9 of 470 u/mL. Of eligible patients, 10 each received FOLFIRINOX or GnP. No significant differences were found between the two groups, except more patients in FOLFIRINOX group had a WHO performance status of 0 (50% vs. 10%, p = 0.057) and had a higher body mass index (27.0 vs. 23.0, p = 0.027). Eleven patients showed partial response (5–FOLFIRINOX and 6–GnP), three progressed during treatment. Five patients (4–FOLFIRINOX, 1–GnP, p = NS) underwent curative surgery. Five patients (1–FOLFIRINOX, 4–Gnp) had radiation and four underwent Nanoknife procedure (3–FOLFIRINOX, 1–GnP). The median progression free survival was 17 months in FOLFIRINOX (95% CI: 5.3-28.6) versus nine months (3.0-15) in GnP group (p = 0.26). The median overall survival was 32 months in FOLFIRINOX (not reach) versus 16 months (9.3-22.7) in GnP group (p = 0.15). Conclusions: The current study suggests that patients with BRPC who received FOLFIRINOX tends to have better outcomes. Future study are warranted to establish a preferred systemic therapy for BRPC.

Treatment strategy for borderline resectable pancreatic cancer with artery involvement.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 373-373
Author(s):  
Seiko Hirono ◽  
Manabu Kawai ◽  
Ken-Ichi Okada ◽  
Motoki Miyazawa ◽  
Atsushi Shimizu ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Neoadjuvant Therapy ◽  
Surgical Resection ◽  
Neoadjuvant Treatment ◽  
Positive Lymph Node ◽  
University Hospital ◽  
High Morbidity ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Borderline Resectable Pancreatic Cancer

373 Background: It has been still controversial to perform surgical resection with borderline resectable pancreatic cancer with artery involvement (BR-A), because an aggressive surgery leads to high morbidity and mortality with low R0 rate for the BR-A patients. In this study, we evaluated whether or not neoadjuvant therapy followed by surgical resection improves survival benefits for BR-A patients. Methods: There were 138 patients with BR-A among 330 pancreatic cancer patients underwent surgical resection at Wakayama Medical University Hospital. We compared clinicopathological factors between 38 BR-A patients with neoadjuvant therapy followed by surgical resection and 100 BR-A patients with upfront surgery to evaluate the clinical impacts of neoadjuvant therapy. Results: The overall survival (OS) of BR-A patients was significantly shorter than that of the patients with borderline resectbale pancreatic cancer with portal vein/ superior mesenteric vein (PV/SMV) involvement (n=76) and resectable pancreatic cancer (n=105) who underwent surgical resection (median OS: 13.6 vs. 20.6 months, P<0.001). The OS of BR-A patient with neoadjuvant therapy followed by surgical resection was significantly longer than those with upfront surgery (median OS: 20.2 vs. 12.9 months, P=0.047). Multivariate analysis showed that older age (P=0.027), pathological PV/SMV invasion (P=0.031), moderated or poor differentiated tumor (P=0.008), positive lymph node ratio ³a0.1 (P=0.018), and no postoperative adjuvant chemotherapy (P<0.001) were independent poor prognostic factors for BR-A patients. Conclusions: Neoadjuvant treatment might bring the clinical benefits for BR-A patients, and it is important to develop the appropriate regimen of neoadjuvant therapy and postoperative adjuvant therapy for longer survival in BR-A patients. Clinical trial information: 000003795.

scholarly journals Neoadjuvant therapy may lead to successful surgical resection and improved survival in patients with borderline resectable pancreatic cancer

HPB ◽  
2010 ◽  
Vol 12 (1) ◽  
pp. 73-79 ◽  
Author(s):  
Rebecca J. McClaine ◽  
Andrew M. Lowy ◽  
Jeffrey J. Sussman ◽  
Nathan Schmulewitz ◽  
David L. Grisell ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Neoadjuvant Therapy ◽  
Surgical Resection ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Borderline Resectable Pancreatic Cancer
Sign in / Sign up

Export Citation Format

Share Document