Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centre
INTRODUCTION: Pancreatic cancer (PC), even in the absence of metastatic disease, has a dismal prognosis. One-third of them are borderline resectable (BRPC) or locally advanced unresectable PC (LAUPC) at diagnosis. There are limited prospective data supporting the best approach on these tumours. Neoa...
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| Format: | Article |
| Status: | Published version |
| Publication date: | 2020 |
| Country: | España |
| Institution: | INCLIVA |
| Repository: | r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA |
| OAI Identifier: | oai:incliva.fundanetsuite.com:p15116 |
| Online Access: | https://incliva.portalinvestigacion.com/publicaciones/15116 |
| Access Level: | Open access |
| Keyword: | borderline resectable locally advanced unresectable pancreatic cancer neoadjuvant therapy FOLFIRINOX |
| _version_ | 1878735907522084864 |
|---|---|
| author | Rosello, Susana |
| author2 | Pizzo, Claudio Huerta, Marisol Munoz, Elena Aliaga, Roberto Vera, Almudena Alfaro-Cervello, Clara Jorda, Esther Garces-Albir, Marina Roda, Desamparados Dorcaratto, Dimitri Tarazona, Noelia Torondel, Sergio Guijarro, Jorge Sanchiz, Vicente Gambardella, Valentina Fleitas-Kanonnikoff, Tania Lluch, Paloma Pascual, Isabel Ferrandez, Antonio Sabater, Luis Cervantes, Andres |
| author2_role | author author author author author author author author author author author author author author author author author author author author author |
| author_browse | Alfaro-Cervello, Clara Aliaga, Roberto Cervantes, Andres Dorcaratto, Dimitri Ferrandez, Antonio Fleitas-Kanonnikoff, Tania Gambardella, Valentina Garces-Albir, Marina Guijarro, Jorge Huerta, Marisol Jorda, Esther Lluch, Paloma Munoz, Elena Pascual, Isabel Pizzo, Claudio Roda, Desamparados Rosello, Susana Sabater, Luis Sanchiz, Vicente Tarazona, Noelia Torondel, Sergio Vera, Almudena |
| author_facet | Rosello, Susana Pizzo, Claudio Huerta, Marisol Munoz, Elena Aliaga, Roberto Vera, Almudena Alfaro-Cervello, Clara Jorda, Esther Garces-Albir, Marina Roda, Desamparados Dorcaratto, Dimitri Tarazona, Noelia Torondel, Sergio Guijarro, Jorge Sanchiz, Vicente Gambardella, Valentina Fleitas-Kanonnikoff, Tania Lluch, Paloma Pascual, Isabel Ferrandez, Antonio Sabater, Luis Cervantes, Andres |
| author_role | author |
| collection | r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA |
| description | INTRODUCTION: Pancreatic cancer (PC), even in the absence of metastatic disease, has a dismal prognosis. One-third of them are borderline resectable (BRPC) or locally advanced unresectable PC (LAUPC) at diagnosis. There are limited prospective data supporting the best approach on these tumours. Neoadjuvant chemotherapy (ChT) is being increasingly used in this setting. METHODS: This is a retrospective series of consecutive patients staged as BRPC or LAUPC after discussion in the multidisciplinary board (MDB) at an academic centre. All received neoadjuvant ChT, followed by chemoradiation (ChRT) in some cases, and those achieving enough downstaging had a curative-intent surgery. Descriptive data about patient's characteristics, neoadjuvant treatments, toxicities, curative resections, postoperative complications, pathology reports and adjuvant treatment were collected. Overall survival (OS) and progression-free survival was calculated with Kaplan-Meier method and log-rank test. RESULTS: Between August 2011 and July 2019, 49 patients fulfilled the inclusion criteria, and all of them received neoadjuvant ChT. Fluorouracil+folinicacid, irinotecan and oxaliplatin was the most frequently used scheme (77%). The most prevalent grade 3 or 4 toxicities were neutropenia (26.5%), neurotoxicity (12.2%), diarrhoea (8.2%) and nausea (8.2%). 18 patients (36.7%) received ChRT thereafter. In total, 22 patients (44,9%) became potentially resectable and 19 of them had an R0 or R1 pancreatic resection. One was found to be unresectable at surgery and two refused surgery. A vascular resection was required in 7 (35%). No postoperative deaths were observed. Postoperative ChT was given to 12 (66.7%) of resected patients. Median OS of the whole cohort was 24,9 months (95%CI 14.1 to 35.7), with 30.6 months for resected and 13.1 months for non-resected patients, respectively (p<0.001). CONCLUSION: A neoadjuvant approach in BRPC and LAUPC was well tolerated and allowed a curative resection in 38.8% of them with a potential improvement on OS. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | ES_856436d3eca17f1897221e2c01f07d60 |
| institution | INCLIVA |
| instname_str | INCLIVA |
| network_acronym_str | ES |
| network_name_str | España |
| oai_identifier_str | oai:incliva.fundanetsuite.com:p15116 |
| publishDate | 2020 |
| publishDateSort | 2020 |
| publisher | ELSEVIER |
| publisherStr | ELSEVIER |
| reponame_str | r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA |
| spelling | Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centre Rosello, Susana Pizzo, Claudio Huerta, Marisol Munoz, Elena Aliaga, Roberto Vera, Almudena Alfaro-Cervello, Clara Jorda, Esther Garces-Albir, Marina Roda, Desamparados Dorcaratto, Dimitri Tarazona, Noelia Torondel, Sergio Guijarro, Jorge Sanchiz, Vicente Gambardella, Valentina Fleitas-Kanonnikoff, Tania Lluch, Paloma Pascual, Isabel Ferrandez, Antonio Sabater, Luis Cervantes, Andres borderline resectable locally advanced unresectable pancreatic cancer neoadjuvant therapy FOLFIRINOX INTRODUCTION: Pancreatic cancer (PC), even in the absence of metastatic disease, has a dismal prognosis. One-third of them are borderline resectable (BRPC) or locally advanced unresectable PC (LAUPC) at diagnosis. There are limited prospective data supporting the best approach on these tumours. Neoadjuvant chemotherapy (ChT) is being increasingly used in this setting. METHODS: This is a retrospective series of consecutive patients staged as BRPC or LAUPC after discussion in the multidisciplinary board (MDB) at an academic centre. All received neoadjuvant ChT, followed by chemoradiation (ChRT) in some cases, and those achieving enough downstaging had a curative-intent surgery. Descriptive data about patient's characteristics, neoadjuvant treatments, toxicities, curative resections, postoperative complications, pathology reports and adjuvant treatment were collected. Overall survival (OS) and progression-free survival was calculated with Kaplan-Meier method and log-rank test. RESULTS: Between August 2011 and July 2019, 49 patients fulfilled the inclusion criteria, and all of them received neoadjuvant ChT. Fluorouracil+folinicacid, irinotecan and oxaliplatin was the most frequently used scheme (77%). The most prevalent grade 3 or 4 toxicities were neutropenia (26.5%), neurotoxicity (12.2%), diarrhoea (8.2%) and nausea (8.2%). 18 patients (36.7%) received ChRT thereafter. In total, 22 patients (44,9%) became potentially resectable and 19 of them had an R0 or R1 pancreatic resection. One was found to be unresectable at surgery and two refused surgery. A vascular resection was required in 7 (35%). No postoperative deaths were observed. Postoperative ChT was given to 12 (66.7%) of resected patients. Median OS of the whole cohort was 24,9 months (95%CI 14.1 to 35.7), with 30.6 months for resected and 13.1 months for non-resected patients, respectively (p<0.001). CONCLUSION: A neoadjuvant approach in BRPC and LAUPC was well tolerated and allowed a curative resection in 38.8% of them with a potential improvement on OS. ELSEVIER https://incliva.portalinvestigacion.com/publicaciones/15116 |
| spellingShingle | Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centre Rosello, Susana borderline resectable locally advanced unresectable pancreatic cancer neoadjuvant therapy FOLFIRINOX |
| status_str | publishedVersion |
| title | Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centre |
| title_full | Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centre |
| title_fullStr | Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centre |
| title_full_unstemmed | Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centre |
| title_short | Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centre |
| title_sort | Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centre |
| topic | borderline resectable locally advanced unresectable pancreatic cancer neoadjuvant therapy FOLFIRINOX |
| topic_facet | borderline resectable locally advanced unresectable pancreatic cancer neoadjuvant therapy FOLFIRINOX |
| url | https://incliva.portalinvestigacion.com/publicaciones/15116 |