Predictors of Resectability and Survival in Patients With Borderline and Locally Advanced Pancreatic Cancer who Underwent Neoadjuvant Treatment With FOLFIRINOX

Objective: The aim of this study was to determine (1) whether preoperative factors can predict resectability of borderline resectable (BR) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant FOLFIRINOX, (2) which patients might benefit from adjuvant therapy, and (3) survival differences between resected BR/LA patients who received neoadjuvant FOLFIRINOX and upfront resected patients. Background: Patients with BR/LA PDAC are often treated with FOLFIRINOX to obtain a margin-negative resection, yet selection of patients for resection remains challenging. Methods: Clinicopathologic data of PDAC patients surgically explored between 04/2011-11/2016 in a single institution were retrospectively collected. Results: Following neoadjuvant FOLFIRINOX, 141 patients were surgically explored (BR: 49%, LA: 51%) and 110 (78%) were resected. Resected patients had lower preoperative CA 19-9 levels (21 vs 40 U/mL, P = 0.03) and smaller tumors on preoperative computed tomography (CT) scan (2.3 vs 3.0 cm, P = 0.03), but no predictors of resectability were identified. Median overall survival (OS) was 34.2 months from diagnosis for all FOLFIRINOX patients and 37.7 months for resected patients. Among resected patients, preoperative CA 19-9>100 U/mL and>8 months between diagnosis and surgery predicted a shorter postoperative disease-free survival (DFS); Charlson comorbidity index>1, preoperative CA 19-9>100 U/mL and tumor size (>3.0 c...
Source: Annals of Surgery - Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

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CONCLUSION: The 'triangle operation' for borderline resectable pancreatic head cancer can be achieved safely by laparoscopy in carefully selected patients.1-11 Proven experience in both open and laparoscopic pancreatic surgery is mandatory. PMID: 31802299 [PubMed - as supplied by publisher]
Source: Ann Oncol - Category: Cancer & Oncology Authors: Tags: Ann Surg Oncol Source Type: research
Abstract BACKGROUND: Neoadjuvant therapy has shown value in various cancer types. The role of neoadjuvant therapy in pancreatic ductal adenocarcinoma (PDAC), however, remains unknown. The aim of the present work is to evaluate the effect of neoadjuvant therapy on the survival of patients with borderline-resectable PDAC. PATIENTS AND METHODS: Between 2004 and 2015, 7730 patients with resectable PDAC and 1980 patients with borderline-resectable PDAC were identified from the National Cancer Database (NCDB). Survival was compared between resectable and borderline-resectable patients. Survival and pathologic chara...
Source: Ann Oncol - Category: Cancer & Oncology Authors: Tags: Ann Surg Oncol Source Type: research
ConclusionThe ‘triangle operation’ forborderline resectable pancreatic head cancer can be achieved safely by laparoscopy in carefully selected patients.1–11 Proven experience in both open and laparoscopic pancreatic surgery is mandatory.
Source: Annals of Surgical Oncology - Category: Cancer & Oncology Source Type: research
AbstractBackgroundNeoadjuvant therapy has shown value in various cancer types. The role of neoadjuvant therapy in pancreatic ductal adenocarcinoma (PDAC), however, remains unknown. The aim of the present work is to evaluate the effect of neoadjuvant therapy on the survival of patients with borderline-resectable PDAC.Patients and MethodsBetween 2004 and 2015, 7730 patients with resectable PDAC and 1980 patients with borderline-resectable PDAC were identified from the National Cancer Database (NCDB). Survival was compared between resectable and borderline-resectable patients. Survival and pathologic characteristics were also...
Source: Annals of Surgical Oncology - Category: Cancer & Oncology Source Type: research
CONCLUSIONS: NeoTx is not only cytotoxic, but has pleiotropic, beneficial effects on all cellular and non-cellular components of PCa. Combinational approaches including immunotherapy may unleash long-term and more effective anti-tumor responses and improve prognosis of PCa. PMID: 31585935 [PubMed - as supplied by publisher]
Source: Clinical Cancer Research - Category: Cancer & Oncology Authors: Tags: Clin Cancer Res Source Type: research
Publication date: Available online 30 August 2019Source: Seminars in Ultrasound, CT and MRIAuthor(s): Axel Dallongeville, Lucie Corno, Stéphane Silvera, Isabelle Boulay-Coletta, Marc ZinsAbstractComputed Tomography remains the optimal imaging modality for both diagnosis and staging of pancreatic adenocarcinoma. Especially, CT is highly accurate in assessing the relationship of the tumor to critical arterial and venous structures, since their involvement can preclude surgical resection or indicate a neoadjuvant strategy in borderline resectable or locally advanced lesions. MRI provides additional staging information ...
Source: Seminars in Ultrasound, CT and MRI - Category: Radiology Source Type: research
Although pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy, incremental progress has been realized over the past decade with new chemotherapeutic regimens, advanced surgical techniques, and an improved understanding of genetics. Although most patients are not candidates for surgical resection because of metastatic disease, many centers are focused on offering curative treatment for patients with borderline resectable (BR) or locally advanced (LA) tumors. These patients are treated with chemotherapy and radiation up front followed by surgical resection, and surgery often includes the resection and reconstr...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research
CONCLUSIONSUp-front TP associated to SVR was predictive of worse survival in borderline resectable PDAC. Perioperative treatments in high-risk surgical groups may improve such poor outcomes.
Source: Hepatobiliary and Pancreatic Diseases International - Category: Gastroenterology Source Type: research
Publication date: Available online 23 May 2019Source: Hepatobiliary &Pancreatic Diseases InternationalAuthor(s): June S Peng, Jane Wey, Sricharan Chalikonda, Daniela S Allende, R Matthew Walsh, Gareth Morris-StiffAbstractBackgroundPrevious studies have demonstrated the prognostic significance of pathologic tumor response in pancreatic adenocarcinoma following neoadjuvant therapy (NAT). The aim of this study was to determine the incidence of significant pathologic response to NAT in borderline resectable pancreatic cancer (BRPC), and association of NAT regimen and other clinico-pathologic characteristics with pathologic...
Source: Hepatobiliary and Pancreatic Diseases International - Category: Gastroenterology Source Type: research
SummaryAlthough some improvements have been made in recent years, the prognosis of pancreatic ductal adenocarcinoma remains poor. Surgical resection followed by adjuvant systemic therapy is the only curative treatment option in early stage disease. The role of radiotherapy in the treatment of pancreatic cancer is not well defined and still controversially discussed. Following the results of the ESPAC-1 trial, adjuvant radiochemotherapy (RCT) was no longer employed in most European countries. Nevertheless, in high-risk situations for local recurrence, the addition of adjuvant radiochemotherapy to adjuvant systemic therapy s...
Source: European Surgery - Category: Surgery Source Type: research
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