Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer.

Published on Jul 1, 2018in British Journal of Surgery6.939
· DOI :10.1002/BJS.10870
Eva Versteijne11
Estimated H-index: 11
,
J.A. Vogel3
Estimated H-index: 3
+ 7 AuthorsG. van Tienhoven24
Estimated H-index: 24
Sources
Abstract
markdownabstractBackground: Studies comparing upfront surgery with neoadjuvant treatment in pancreatic cancer may report only patients who underwent resection and so survival will be skewed. The aim of this study was to report survival by intention to treat in a comparison of upfront surgery versus neoadjuvant treatment in resectable or borderline resectable pancreatic cancer. Methods: MEDLINE, Embase and the Cochrane Library were searched for studies reporting median overall survival by intention to treat in patients with resectable or borderline resectable pancreatic cancer treated with or without neoadjuvant treatment. Secondary outcomes included overall and R0 resection rate, pathological lymph node rate, reasons for unresectability and toxicity of neoadjuvant treatment. Results: In total, 38 studies were included with 3484 patients, of whom 1738 (49·9 per cent) had neoadjuvant treatment. The weighted median overall survival by intention to treat was 18·8months for neoadjuvant treatment and 14·8months for upfront surgery; the difference was larger among patients whose tumours were resected (26·1 versus 15·0months respectively). The overall resection rate was lower with neoadjuvant treatment than with upfront surgery (66·0 versus 81·3 per cent; P<0·001), but the R0 rate was higher (86·8 (95 per cent c.i. 84·6 to 88·7) versus 66·9 (64·2 to 69·6) per cent; P<0·001). Reported by intention to treat, the R0 rates were 58·0 and 54·9 per cent respectively (P=0·088). The pathological lymph node rate was 43·8 per cent after neoadjuvant therapy and 64·8 per cent in the upfront surgery group (P<0·001). Toxicity of at least grade III was reported in up to 64 per cent of the patients. Conclusion: Neoadjuvant treatment appears to improve overall survival by intention to treat, despite lower overall resection rates for resectable or borderline resectable pancreatic cancer. PROSPERO registration number: CRD42016049374.
📖 Papers frequently viewed together
20143.98Surgery
20 Authors (Do-Youn Oh)
References67
Newest
#1Knut Jørgen Labori (Oslo University Hospital)H-Index: 22
#2Kristoffer Lassen (Oslo University Hospital)H-Index: 7
Last. Svein Dueland (Oslo University Hospital)H-Index: 28
view all 10 authors...
Background Pancreatic cancer is the fourth leading cause of cancer-related death. While surgical resection remains the foundation for potentially curative treatment, survival benefit is achieved with adjuvant oncological treatment. Thus, completion of multimodality treatment (surgical resection and (neo)adjuvant chemotherapy) to all patients and early treatment of micrometastatic disease is the ideal goal. NorPACT–1 aims to test the hypothesis that overall mortality at one year after allocation ...
Source
#1Marianne SinnH-Index: 20
#2Marcus BahraH-Index: 38
Last. Hanno RiessH-Index: 45
view all 21 authors...
PurposeGemcitabine is standard of care in the adjuvant treatment of resectable pancreatic ductal adenocarcinoma (PDAC). The epidermal growth factor receptor tyrosine kinase inhibitor erlotinib in combination with gemcitabine has shown efficacy in the treatment of advanced PDAC and was considered to improve survival in patients with primarily resectable PDAC after R0 resection.Patients and MethodsIn an open-label, multicenter trial, patients were randomly assigned to one of two study arms: gemcit...
Source
#1John P. Neoptolemos (University of Liverpool)H-Index: 127
#2Daniel H. Palmer (University of Liverpool)H-Index: 46
Last. Jonathan Wadsley (Weston Park Hospital)H-Index: 26
view all 34 authors...
Summary Background The ESPAC-3 trial showed that adjuvant gemcitabine is the standard of care based on similar survival to and less toxicity than adjuvant 5-fluorouracil/folinic acid in patients with resected pancreatic cancer. Other clinical trials have shown better survival and tumour response with gemcitabine and capecitabine than with gemcitabine alone in advanced or metastatic pancreatic cancer. We aimed to determine the efficacy and safety of gemcitabine and capecitabine compared with gemc...
Source
#1Yoshiaki Murakami (Hiroshima University)H-Index: 44
#2Kenichiro Uemura (Hiroshima University)H-Index: 35
Last. Taijiro Sueda (Hiroshima University)H-Index: 56
view all 8 authors...
Purpose The aim of this study was to evaluate the efficacy of neoadjuvant gemcitabine plus S-1 (GS) chemotherapy as measured by overall survival for patients with pancreatic carcinoma with arterial contact.
Source
#1Tsutomu Fujii (Nagoya University)H-Index: 56
#2Sohei Satoi (Kansai Medical University)H-Index: 33
Last. Yasuhiro Kodera (Nagoya University)H-Index: 83
view all 12 authors...
Background The efficacy of neoadjuvant chemoradiotherapy (NACRT) and subset of pancreatic ductal adenocarcinoma (PDAC) patients who are most likely to benefit from this strategy remain elusive. The aim of this study was to investigate the effects of NACRT in patients with resectable (R) or borderline resectable (BR) adenocarcinoma of the pancreatic head. BR diseases were classified into two groups: lesions involving exclusively the portal vein system (BR-PV) and those abutting the major artery (...
Source
#1Seiko Hirono (Wakayama Medical University)H-Index: 33
#2Manabu KawaiH-Index: 36
Last. Hiroki YamaueH-Index: 69
view all 8 authors...
We evaluated whether neoadjuvant therapy followed by surgical resection improves the clinical outcome for patients with borderline resectable pancreatic cancer with radiologic artery involvement (BRPC-A).We reviewed 143 BRPC-A patients from among 330 pancreatic cancer patients, including 111 potentially resectable pancreatic cancer patients and 76 borderline resectable pancreatic cancer with portal/superior mesenteric vein involvement patients, who underwent surgery at Wakayama Medical Universit...
Source
#3Jordan M. Cloyd (University of Texas MD Anderson Cancer Center)H-Index: 22
Background The impact of preoperative chemoradiation on postoperative morbidity and mortality of patients with pancreatic adenocarcinoma remains controversial.
Source
#1Walid L. Shaib (Emory University)H-Index: 20
#2Natalyn Hawk (Emory University)H-Index: 8
Last. Bassel F. El-Rayes (Emory University)H-Index: 52
view all 11 authors...
Purpose A challenge in borderline resectable pancreatic cancer (BRPC) management is the high rate of positive posterior margins (PM). Stereotactic body radiation therapy (SBRT) allows for higher radiation delivery dose with conformity. This study evaluated the maximal tolerated dose with a dose escalation plan level up to 45 Gy using SBRT in BRPC. Methods and Materials A single-institution, 3 + 3 phase 1 clinical trial design was used to evaluate 4 dose levels of SBRT delivered in 3 fractions to...
Source
#1Maikel BakensH-Index: 5
Last. Ignace H.J.T. de HinghH-Index: 45
view all 8 authors...
textabstractAdjuvant chemotherapy after pancreatoduodenectomy for pancreatic cancer is currently considered standard of care. In this nationwide study, we investigated which characteristics determine the likelihood of receiving adjuvant chemotherapy and its effect on overall survival. The data were obtained from the Netherlands Cancer Registry. All patients alive 90 days after pancreatoduodenectomy for M0-pancreatic cancer between 2008 and 2013 in the Netherlands were included in this study. The...
Source
#1Benedetto IelpoH-Index: 16
#2Hipolito DuranH-Index: 13
Last. Emilio VicenteH-Index: 18
view all 12 authors...
Abstract Introduction Recently, novel chemotherapeutic agents like nab-paclitaxel and gemcitabine demonstrated a survival benefit over gemcitabine alone in metastatic pancreatic cancer. However, there are limited clinical results using this chemotherapy in potentially resectable pancreatic adenocarcinoma. Our aim is to report the oncological results of patients affected by potentially resectable pancreatic adenocarcinoma that underwent surgery after a combination of gemcitabine and nab-paclitaxe...
Source
Cited By190
Newest
#1Mike Nguyen (Monash University)
#2Eva Segelov (Monash University)H-Index: 25
Last. Amitesh Roy (Flinders University)H-Index: 13
view all 17 authors...
Introduction null Pancreatic cancer remains a challenging malignancy due to the high proportion of patients diagnosed at advanced stages and the limited treatment options. This article discusses recent evidence in the management of both localised and advanced pancreatic cancer and offers an expert opinion on current best practice. null Areas covered null For patients with localised disease, the evidence for adjuvant chemotherapy is discussed as well as emerging neoadjuvant approaches for resecta...
Source
#1Dominique Lisa Birrer (UZH: University of Zurich)H-Index: 1
#2Henriette Golcher (FAU: University of Erlangen-Nuremberg)H-Index: 9
Last. Robert Grützmann (FAU: University of Erlangen-Nuremberg)H-Index: 64
view all 27 authors...
OBJECTIVE The aim of this study was to pool data from randomized controlled trials (RCT) limited to resectable pancreatic ductal adenocarcinoma (PDAC) to determine whether a neoadjuvant therapy impacts on disease-free survival (DFS) and surgical outcome. SUMMARY BACKGROUND DATA Few underpowered studies have suggested benefits from neoadjuvant chemo (± radiation) for strictly resectable PDAC without offering conclusive recommendations. METHODS Three RCTs were identified comparing neoadjuvant chem...
Source
#1Yuji Kitahata (Wakayama Medical University)H-Index: 19
#2Manabu Kawai (Wakayama Medical University)H-Index: 36
Last. Hiroki Yamaue (Wakayama Medical University)H-Index: 69
view all 10 authors...
Background null Circulating tumor DNA (ctDNA) might be a promising biomarker for pancreatic cancer in liquid biopsy. This study aimed to evaluate the usefulness of liquid biopsy for patients with borderline-resectable pancreatic cancer (BR-PC). null Methods null Patients with BR-PC according to the National Comprehensive Cancer Network guidelines (2017) and eligible for neoadjuvant chemotherapy (NAC) followed by pancreatectomy were recruited at Wakayama Medical University Hospital (UMIN000026647...
Source
#1Jiarui Li (Peking Union Medical College Hospital)H-Index: 6
#2Xun Li (Beijing University of Chinese Medicine)H-Index: 10
Last. Kaili Yang (Peking Union Medical College Hospital)H-Index: 2
view all 4 authors...
Source
#1Jae Seung Kang (New Generation University College)H-Index: 24
#2Yoo Jin Choi (New Generation University College)H-Index: 6
Last. Jin-Young Jang (New Generation University College)H-Index: 55
view all 10 authors...
Background null Major vessel invasion is an important factor for determining the surgical approach and long-term prognosis for patients with pancreatic head cancer. However, clinical implications of vessel invasion have seldom been reported in pancreatic body or tail cancer. This study aimed to evaluate the clinical relevance of splenic vessel invasion with pancreatic body or tail cancer compared with no invasion and investigate prognostic factors. null Methods null This study enrolled patients ...
Source
#2Lin Yang (Peking Union Medical College)H-Index: 20
Long-term survival of a patient with pancreatic cancer and lung metastasis: A case report and review of literature
Source
#1Manish Manrai (Armed Forces Medical College)H-Index: 3
Source
#1Boris V. Janssen (UvA: University of Amsterdam)H-Index: 2
#2Rutger Theijse (UvA: University of Amsterdam)
Last. Pieter Valkema (UvA: University of Amsterdam)
view all 14 authors...
Background: Histologic examination of resected pancreatic cancer after neoadjuvant therapy (NAT) is used to assess the effect of NAT and may guide the choice for adjuvant treatment. However, evaluating residual tumor burden in pancreatic cancer is challenging given tumor response heterogeneity and challenging histomorphology. Artificial intelligence techniques may offer a more reproducible approach. Methods: From 64 patients, one H&E-stained slide of resected pancreatic cancer after NAT was digi...
Source
#1Jean GugenheimH-Index: 58
#2Anna Crovetto (Sapienza University of Rome)H-Index: 1
Last. Niccolò Petrucciani (Sapienza University of Rome)H-Index: 20
view all 3 authors...
Multimodal treatment including surgery and chemotherapy is considered the gold standard treatment of pancreatic cancer by most guidelines. Neoadjuvant therapy (NAT) has been seen as a possible treatment option for resectable, borderline resectable and locally advanced PaC. The aim of this paper is to offer a state-of-the-art review on neoadjuvant treatments in the setting of pancreatic ductal adenocarcinoma. A systematic literature search was performed using PubMed, Cochrane, Web of Science and ...
Source
#1Keinosuke Ishido (Hirosaki University)H-Index: 11
#2Norihisa Kimura (Hirosaki University)H-Index: 11
Last. Kenichi Hakamada (Hirosaki University)H-Index: 24
view all 8 authors...
BACKGROUND Resectable pancreatic ductal adenocarcinoma (R-PDAC) often recurs early after radical resection, which is associated with poor prognosis. Predicting early recurrence preoperatively is useful for determining the optimal treatment. PATIENTS AND METHODS One hundred and seventy-eight patients diagnosed with R-PDAC on computed tomography (CT) imaging and undergoing radical resection at Hirosaki University Hospital from 2005 to 2019 were retrospectively analyzed. Patients with recurrence wi...
Source
This website uses cookies.
We use cookies to improve your online experience. By continuing to use our website we assume you agree to the placement of these cookies.
To learn more, you can find in our Privacy Policy.