scholarly journals Use of FOLFIRINOX or Nab-Paclitaxel Plus Gemcitabine for the Treatment of Locally Advanced Pancreatic Adenocarcinoma: A Single Institution Observational Study

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4939
Author(s):  
Alberto Servetto ◽  
Antonio Santaniello ◽  
Fabiana Napolitano ◽  
Francesca Foschini ◽  
Roberta Marciano ◽  
...  
Keyword(s):  
Median Overall Survival ◽  
Locally Advanced ◽  
Distant Metastases ◽  
Ductal Adenocarcinoma ◽  
Controlled Clinical Trials ◽  
Single Institution ◽  
Locally Advanced Pancreatic Adenocarcinoma ◽  
Grade 3 ◽  
Advanced Pancreatic Adenocarcinoma

Patients with locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) do not present distant metastases but are not eligible for surgery upfront. Chemotherapy regimens, such as FOLFIRINOX (FFN) or nab-paclitaxel plus gemcitabine (GemNab) in combination with loco-regional treatments are generally used in this setting. However, the best treatment choice is unknown. We retrospectively analyzed the information of 225 patients with stage II–III PDAC treated at our institution between October 2011 and December 2020. A total of 94 patients with LA PDAC who are non-eligible for surgery upfront received neoadjuvant FFN or GemNab. Of the 67 patients receiving FFN, 28 (41.8%) underwent surgery after neoadjuvant therapy. Of the 27 patients treated with GemNab, 6 (22.2%) became eligible for resection. The median overall survival (OS) was 85.1 weeks and 54.3 weeks in the FFN and GemNab groups, respectively (HR = 0.54, p = 0.0109). The median OS was 189.7 weeks and 76.4 weeks in the resected and unresected cohorts, respectively (HR = 0.25, p < 0.0001). Neutropenia (37.3%), anemia (6.0%), and diarrhea (6.0%) in the FFN group and neutropenia (22.2%) and thrombocytopenia (18.5%) in the GemNab groups were the most frequent grade 3–4 side effects. Higher rates of thrombocytosis (p < 0.0001) and peripheral edema (p < 0.0001) were observed in the GemNab group. Our results suggest that the use of FFN is associated with more favorable clinical outcomes than GemNab for patients with LA PDAC. Future randomized and controlled clinical trials are needed to further elucidate the role of these regimens and loco-regional treatments in this setting.

Surgical resectability after neo-adjuvant FOLFIRINOX for borderline or locally advanced pancreatic adenocarcinoma.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 421-421 ◽  
Author(s):  
Mathias Alline ◽  
Pierre Emmanuel Colombo ◽  
François Quenet ◽  
Marta Jarlier ◽  
Fabienne Portales ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Pathologic Response ◽  
Primary Analysis ◽  
Surgical Morbidity ◽  
Borderline Resectable ◽  
Locally Advanced Pancreatic Adenocarcinoma ◽  
Global Survival ◽  
Grade 3 ◽  
Advanced Pancreatic Adenocarcinoma

421 Background: FOLFIRINOX has already demonstrated its efficiency in metastatic pancreatic cancer (PC). This combination need to be assessed in a neoadjuvant situation for locally advanced non metastatic PC. Methods: From 2009 to 2013, 31 patients with borderline or locally advanced PC received a neoadjuvant treatment with FOLFIRINOX so as to get them to a resectable situation. According to the tumoral response, chemoradiotherapy with gemcitabine was done. The primary analysis endpoint was the resecability rate. Pathologic response, chemotherapy’s toxicity and surgical morbidity were also evaluated. Results: Among the 31 PC, 17 were borderline resectable and 14 locally advanced according to NCCN classification. 16 (52%) received complete chemotherapy with a median of 4 cycles. Toxicity lead to treatment modification or interruption for 9 patients (29%). Grade 3-4 toxicity occurred in 7 patients (24%). 22 patients (71%) underwent chemoradiotherapy after FOLFIRINOX chemotherapy. 13 patients (42%) had disease progression under treatment whereas 18 patients with objective radiologic response or at least stable disease were surgically explored with a resection completed in 13 cases (42%). Surgical morbidity was controlled with grade 1-2 complications for 9 patients (69%) and no mortality. 11 patients (35%) demonstrated a significant pathologic response. Resected patients had a global survival median of 36 months. Conclusions: FOLFIRINOX in a neoadjuvant setting seems feasible with limited morbidity in locally advanced PC with encouraging resecability and pathologic response rates. Resected patients’ survival is promising but need to be confirmed in larger series.

scholarly journals Prognostic Predicting Role of Contrast-Enhanced Computed Tomography for Locally Advanced Pancreatic Adenocarcinoma

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Chien-shan Cheng ◽  
Wei Liu ◽  
Liangping Zhou ◽  
Wei Tang ◽  
Ailing Zhong ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pancreatic Adenocarcinoma ◽  
Locally Advanced ◽  
Tumour Volume ◽  
Contrast Enhanced ◽  
Locally Advanced Pancreatic Adenocarcinoma ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography ◽  
Advanced Pancreatic Adenocarcinoma

Introduction. Contrast-enhanced computed tomography (CECT) imaging is commonly used to assess pancreatic adenocarcinoma (PAC). However, the value of semiquantitative and quantitative assessments of CECT parameters used to predict survival in PAC remains unknown. This study aims to investigate the prognostic role of pretreatment CECT imaging in patients with locally advanced pancreatic adenocarcinoma (LAPAC). Materials and Methods. From June 2013 to May 2017, eighty-six newly diagnosed patients with pathologically and radiologically confirmed LAPAC were retrospectively recruited. All patients were evaluated by CECT and experienced gemcitabine-based chemotherapy. The relationship between overall survival (OS) and clinical factors including age, sex, serum carbohydrate antigen 19-9 value, and CECT findings (including tumour location, tumour volume, peripancreatic involvement, blood vessel involvement, tumour enhanced rate, and distance liver metastasis) was determined using Cox proportional hazard regression models, and a nomogram was constructed for the prediction of 1- and 1.5-year survival rates of patients with LAPAC. Results. On univariate analysis, patients who had a tumour enhanced rate (TER) less than 80.465% and those who had a TER ≥ 80.465% are with a 3.587-fold increase in OS (p<0.001). After multivariate Cox regression, a nomogram was established based on a new model containing the predictive variables of high Ca19-9 level, higher clinical stages, larger tumour volume, the presence of peripancreatic involvement, and liver metastases. The model displayed good accuracy in predicting OS with a C-index of 0.614. The calibration plots also showed a good discrimination and calibration of the nomogram between the predicted and observed survival probabilities. Conclusion. Our results showed that TER can be used to predict survival in LAPAC, and we developed a nomogram for determining the prognosis of patients with LAPAC. However, the purposed nomogram still requires external data verification in future applications.

scholarly journals The Role of Histology on the Outcome of Sinonasal Carcinomas Treated With Radiation Therapy; a Single Institution Experience

2021 ◽  
Author(s):  
Reza Ghalehtaki ◽  
Maryam Taherioun ◽  
Mahdieh razmkhah ◽  
Mohammad Shirkhoda ◽  
Amirmohsen Jalaeefar ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Distant Metastases ◽  
Histological Type ◽  
Histological Subtypes ◽  
Single Institution ◽  
Oncological Outcomes ◽  
Adenoid Cystic ◽  
The Relationship ◽  
Rare Group

Abstract Background: Malignant epithelial sinonasal tumors are a rare group of head and neck cancers with various histological subtypes that can affect the treatment outcomes in the locally advanced tumors.Our aim was to investigate the relationship between oncological outcomes and histological type in sinonasal carcinomas.Material and Method: In this retrospective cohort study we retrieved patients’ information from medical archives. Most of patients underwent surgery and all received radiation as indicated, some patients received chemotherapy. We evaluated 3-year overall survival (OS),distant metastases and local recurrence according to histological type.Results: We studied 28 patients between 2011-2016. Most of them were male. Squamouse cell carcinoma (SCC) was found in 15 (53.5%), Adenoid cystic carcinoma (AdCC) in 8 (28.5%), and Adenocarcinoma (AC) in 5 (18%) patients. The highest rate of metastasis was observed in AC. Three-year OS were 48%, 50% and 73% in SCC, AC and AdCC respectively.Conclusion: The type of histology affects the oncological outcomes and this relationship can dictate the treatment modality to choose when dealing with malignant sinonasal tumors.

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