Neoadjuvant chemotherapy and radiotherapy outcomes in borderline‐resectable and locally‐advanced pancreatic cancer patients
Abstract Background There is no agreed upon standard of care for borderline‐resectable pancreatic cancer (BRPC) or locally‐advanced pancreatic cancer (LAPC) patients regarding the benefit of chemotherapy or radiation alone or in combination. Patients and Methods We completed a retrospective cohort a...
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| Format: | Article |
| Language: | English |
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Wiley
2023-04-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.5523 |
| _version_ | 1797838364552986624 |
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| author | Gregory P. Botta Tridu R. Huynh Samantha R. Spierling‐Bagsic Alexander Agelidis Randolph Schaffer Ray Lin Darren Sigal |
| author_facet | Gregory P. Botta Tridu R. Huynh Samantha R. Spierling‐Bagsic Alexander Agelidis Randolph Schaffer Ray Lin Darren Sigal |
| author_sort | Gregory P. Botta |
| collection | DOAJ |
| description | Abstract Background There is no agreed upon standard of care for borderline‐resectable pancreatic cancer (BRPC) or locally‐advanced pancreatic cancer (LAPC) patients regarding the benefit of chemotherapy or radiation alone or in combination. Patients and Methods We completed a retrospective cohort analysis of BRPC and LAPC patients at a cancer center with expertise in multi‐disciplinary pancreatic ductal adenocarcinoma (PDAC) treatment over a 5‐year period from 03/01/2014 to 03/01/2019 (cut‐off date). The total evaluable newly diagnosed, treatment naïve, BRPC, and LAPC patients with adequate organ function and ability to obtain treatment after multidisciplinary review was 52 patients. After analysis, patients were evaluated for rates of resection, extent of resection (R0 or R1), median progression‐free survival (mPFS), and median overall survival (mOS). Results Patients were treated with chemotherapy alone (gemcitabine and nab‐paclitaxel = 77% (20/26); FOLFIRINOX = 19% (5/26); single agent gemcitabine 3.8% (1/26)), or chemotherapy followed by chemoradiation (gemcitabine +5 Gy × 5 weeks), or chemoradiation alone prior to re‐staging and potential resection. Of the 29% (15/52) of patients who went on to surgical resection, 73% (11/15) achieved R0 resection. An R0 resection was achieved in 35% (9/26) of patients treated with chemotherapy alone, 7.6% (1/13) in a patient treated with chemotherapy followed by radiation, and 7.6% (1/13) with concurrent chemoradiotherapy alone. Chemotherapy alone achieved a mPFS of 16.4 months (p < 0.0025) and mOS of 26.2 months (p < 0.0001), chemotherapy followed by chemoradiation was 13.0 months and 14.9 months respectively, while concurrent chemoradiotherapy was 6.9 months and 7.3 months. Conclusions and Relevance BRPC and LAPC patients capable of surgery after only receiving neoadjuvant treatment with chemotherapy had higher rates of R0 resection with prolonged median PFS and OS compared with any patient needing combination chemotherapy with radiotherapy. |
| first_indexed | 2024-04-09T15:40:40Z |
| format | Article |
| id | doaj.art-3a3335f35a174dbb87f210673552c247 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-04-09T15:40:40Z |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-3a3335f35a174dbb87f210673552c2472023-04-27T10:12:43ZengWileyCancer Medicine2045-76342023-04-011277713772310.1002/cam4.5523Neoadjuvant chemotherapy and radiotherapy outcomes in borderline‐resectable and locally‐advanced pancreatic cancer patientsGregory P. Botta0Tridu R. Huynh1Samantha R. Spierling‐Bagsic2Alexander Agelidis3Randolph Schaffer4Ray Lin5Darren Sigal6Division of Hematology/Oncology, Department of Medicine, Moores Cancer Center University of California San Diego La Jolla California USADivision of Hematology/Oncology, Department of Medicine, Moores Cancer Center University of California San Diego La Jolla California USAScripps Whittier Diabetes Institute Scripps Health San Diego California USAScripps Research Translational Institute La Jolla California USADivision of Hepatopancreatobiliary Surgery Scripps MD Anderson Cancer Center La Jolla California USADivision of Radiation Oncology Scripps MD Anderson Cancer Center La Jolla California USADivision of Medical Oncology Scripps MD Anderson Cancer Center La Jolla California USAAbstract Background There is no agreed upon standard of care for borderline‐resectable pancreatic cancer (BRPC) or locally‐advanced pancreatic cancer (LAPC) patients regarding the benefit of chemotherapy or radiation alone or in combination. Patients and Methods We completed a retrospective cohort analysis of BRPC and LAPC patients at a cancer center with expertise in multi‐disciplinary pancreatic ductal adenocarcinoma (PDAC) treatment over a 5‐year period from 03/01/2014 to 03/01/2019 (cut‐off date). The total evaluable newly diagnosed, treatment naïve, BRPC, and LAPC patients with adequate organ function and ability to obtain treatment after multidisciplinary review was 52 patients. After analysis, patients were evaluated for rates of resection, extent of resection (R0 or R1), median progression‐free survival (mPFS), and median overall survival (mOS). Results Patients were treated with chemotherapy alone (gemcitabine and nab‐paclitaxel = 77% (20/26); FOLFIRINOX = 19% (5/26); single agent gemcitabine 3.8% (1/26)), or chemotherapy followed by chemoradiation (gemcitabine +5 Gy × 5 weeks), or chemoradiation alone prior to re‐staging and potential resection. Of the 29% (15/52) of patients who went on to surgical resection, 73% (11/15) achieved R0 resection. An R0 resection was achieved in 35% (9/26) of patients treated with chemotherapy alone, 7.6% (1/13) in a patient treated with chemotherapy followed by radiation, and 7.6% (1/13) with concurrent chemoradiotherapy alone. Chemotherapy alone achieved a mPFS of 16.4 months (p < 0.0025) and mOS of 26.2 months (p < 0.0001), chemotherapy followed by chemoradiation was 13.0 months and 14.9 months respectively, while concurrent chemoradiotherapy was 6.9 months and 7.3 months. Conclusions and Relevance BRPC and LAPC patients capable of surgery after only receiving neoadjuvant treatment with chemotherapy had higher rates of R0 resection with prolonged median PFS and OS compared with any patient needing combination chemotherapy with radiotherapy.https://doi.org/10.1002/cam4.5523chemotherapypancreatic cancerradiationresection |
| spellingShingle | Gregory P. Botta Tridu R. Huynh Samantha R. Spierling‐Bagsic Alexander Agelidis Randolph Schaffer Ray Lin Darren Sigal Neoadjuvant chemotherapy and radiotherapy outcomes in borderline‐resectable and locally‐advanced pancreatic cancer patients Cancer Medicine chemotherapy pancreatic cancer radiation resection |
| title | Neoadjuvant chemotherapy and radiotherapy outcomes in borderline‐resectable and locally‐advanced pancreatic cancer patients |
| title_full | Neoadjuvant chemotherapy and radiotherapy outcomes in borderline‐resectable and locally‐advanced pancreatic cancer patients |
| title_fullStr | Neoadjuvant chemotherapy and radiotherapy outcomes in borderline‐resectable and locally‐advanced pancreatic cancer patients |
| title_full_unstemmed | Neoadjuvant chemotherapy and radiotherapy outcomes in borderline‐resectable and locally‐advanced pancreatic cancer patients |
| title_short | Neoadjuvant chemotherapy and radiotherapy outcomes in borderline‐resectable and locally‐advanced pancreatic cancer patients |
| title_sort | neoadjuvant chemotherapy and radiotherapy outcomes in borderline resectable and locally advanced pancreatic cancer patients |
| topic | chemotherapy pancreatic cancer radiation resection |
| url | https://doi.org/10.1002/cam4.5523 |
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