Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial

Published on Feb 27, 2020in Journal of Clinical Oncology32.956
· DOI :10.1200/JCO.19.02274
Eva Versteijne11
Estimated H-index: 11
(UvA: University of Amsterdam),
Mustafa Suker12
Estimated H-index: 12
(EUR: Erasmus University Rotterdam)
+ 27 AuthorsGeertjan van Tienhoven35
Estimated H-index: 35
(UvA: University of Amsterdam)
Sources
Abstract
PURPOSEPreoperative chemoradiotherapy may improve the radical resection rate for resectable or borderline resectable pancreatic cancer, but the overall benefit is unproven.PATIENTS AND METHODSIn th...
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References34
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#1W. S. Tummers (LEI: Leiden University)H-Index: 1
#2Jesse V. Groen (LEI: Leiden University)H-Index: 5
Last. Rutger-Jan Swijnenburg (LEI: Leiden University)H-Index: 25
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Background: The prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) is poor and selection of patients for surgery is challenging. This study examined the impact of a positive resection margin (R1) on locoregional recurrence (LRR) and overall survival (OS); and also aimed to identified tumour characteristics and/or technical factors associated with a positive resection margin in patients with PDAC. Methods: Patients scheduled for pancreatic resection for PDAC between 2006 and 2016 ...
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#1Jordan M. CloydH-Index: 24
#2Hsiang Chun Chen (University of Texas MD Anderson Cancer Center)H-Index: 12
Last. Matthew H.G. KatzH-Index: 66
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ObjectivesAlthough the use of neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma is increasing, the optimal preoperative treatment regimen remains poorly defined.MethodsAll patients with resectable pancreatic ductal adenocarcinoma who received preoperative chemotherapy alone (12%) o
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#1Fuyuhiko Motoi (Tohoku University)H-Index: 40
#2Tomoo KosugeH-Index: 86
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: A randomized, controlled trial has begun to compare neoadjuvant chemotherapy using gemcitabine and S-1 with upfront surgery for patients planned resection of pancreatic cancer. Patients were enrolled after the diagnosis of resectable or borderline resectable by portal vein involvement pancreatic cancer with histological confirmation. They were randomly assigned to either neoadjuvant chemotherapy or upfront surgery. Adjuvant chemotherapy using S-1 was administered for 6 months to patients with ...
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#1Thomas Jens Ettrich (University of Ulm)H-Index: 13
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Last. Thomas Seufferlein (University of Ulm)H-Index: 46
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Even clearly resectable pancreatic cancer still has an unfavorable prognosis. Neoadjuvant or perioperative therapies might improve the prognosis of these patients. Thus, evaluation of perioperative chemotherapy in resectable pancreatic cancer in a prospective, randomized trial is warranted. A substantial improvement in overall survival of patients with metastatic pancreatic cancer with FOLFIRINOX and nab-paclitaxel/gemcitabine vs standard gemcitabine has been demonstrated in phase III-trials. In...
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Abstract Background Among patients with metastatic pancreatic cancer, combination chemotherapy with fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) leads to longer overall surviv...
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#1Jin-Young Jang (Seoul National University Hospital)H-Index: 54
#2Youngmin Han (Seoul National University Hospital)H-Index: 10
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Objective:This study was performed to determine whether neoadjuvant treatment increases survival in patients with BRPC.Summary Background Data:Despite many promising retrospective data on the effect of neoadjuvant treatment for borderline resectable pancreatic cancer (BRPC), no high-level evidence e
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#1Lilian Schwarz (University of Rouen)H-Index: 16
#2Dewi Vernerey (French Institute of Health and Medical Research)H-Index: 29
Last. Antonio Sa CunhaH-Index: 31
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Background At time of diagnosis, less than 10% of patients with pancreatic adenocarcinomas (PDAC) are considered to be immediately operable (i.e. resectable). Considering their poor overall survival (OS), only tumours without vascular invasion (NCCN 2017) should be considered for resection, i.e. those for which resection with disease-free margins (R0) is theoretically possible in absence of presurgery treatment. With regard to high R1 rates and undetectable locoregional and/or metastatic spreadi...
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#1Janet E. Murphy (Harvard University)H-Index: 20
#2Jennifer Y. Wo (Harvard University)H-Index: 28
Last. Theodore S. Hong (Harvard University)H-Index: 57
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Importance Patients with borderline-resectable pancreatic ductal adenocarcinoma have historically poor outcomes with surgery followed by adjuvant chemotherapy. Evaluation of a total neoadjuvant approach with highly active therapy is warranted. Objective To evaluate the margin-negative (R0) resection rate in borderline-resectable pancreatic ductal adenocarcinoma after neoadjuvant FOLFIRINOX (fluorouracil, irinotecan, and oxaliplatin) therapy and individualized chemoradiotherapy. Design, Setting, ...
215 CitationsSource
#1Eva VersteijneH-Index: 11
#2J.A. VogelH-Index: 4
Last. G. van TienhovenH-Index: 21
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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 intenti...
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Summary Background Pancreatic ductal adenocarcinoma are known to metastasise early and a rationale exists for the investigation of preoperative chemotherapy in patients with resectable disease. We aimed to assess the role of combination chemotherapy in this setting in the PACT-15 trial. Methods We did this randomised, open-label, phase 2–3 trial in ten hospitals in Italy. We report the phase 2 part here. Patients aged 18–75 years who were previously untreated for pancreatic ductal adenocarcinoma...
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Panc reatic ductal adenocarcinoma (PDAC) is a devastating malignancy. There have been few advances that have substantially improved overall survival in the past several years. On its current trajectory, the deaths from PDAC are expected to cross that from all gastrointestinal cancers combined by 2030. Radiation therapy is a technically very complex modality that bridges multiple different treatment strategies. It represents a hybrid among advanced diagnostic imaging, local (often ablative) inter...
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#1Keinosuke Ishido (Hirosaki University)H-Index: 11
#2Norihisa Kimura (Hirosaki University)H-Index: 11
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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...
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#1Lynn E. Nooijen (UvA: University of Amsterdam)H-Index: 2
#2Lotte C. FrankenH-Index: 5
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Background null In this retrospective cohort study, the potential of gemcitabine (gem)/cisplatin (cis) chemotherapy as future preoperative therapy for patients with unresectable locally advanced or borderline resectable intrahepatic, perihilar, and mid-cholangiocarcinoma was investigated. null Methods null All patients with intrahepatic, perihilar, and mid-cholangiocarcinoma presented at Amsterdam UMC between January 2016 and October 2019 were included. The radiologic response after 3 and/or 6 c...
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#1Erin P Ward (MCW: Medical College of Wisconsin)
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Over the last two decades, there have been significant changes in the management of patients with localized pancreatic cancer. The rationale for an evolution toward a neoadjuvant approach and summary of relevant clinical trials is reviewed. Controversies in identifying optimal neoadjuvant therapeutic approaches are discussed.
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Neoadjuvant treatment: A window of opportunity for nutritional prehabilitation in patients with pancreatic ductal adenocarcinoma
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To investigate if a simplified image based scoring system assessing treatment response after neoadjuvant therapy (NAT) can predict survival in patients with pancreatic ductal adenocarcinoma (PDAC) who achieved subsequent R0 resection. Retrospective analysis of 57 PDAC patients (male = 29, 51%) with mean age of 64 at diagnosis (range 42–79) who received NAT and R0 resection. Post-NAT overall, arterial and venous imaging response was characterized as improved, similar, or worse by 2 readers indepe...
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The 21st annual Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) was held in Calgary, Alberta, 20–21 September 2019. The WCGCCC is an interactive multi-disciplinary conference attended by health care professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists, pathologists, radiologists, and allied health care professionals such as...
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Pancreatic cancer is one of the most aggressive diseases in the world due to a lack of early detection, leading to an overall 5-year survival of only 10%. In recent years, clinical trials targeted pancreatic cancer in efforts to improve survival. These studies introduce new technologies, concepts, and evidence which have instilled new optimism for improving prognosis. This review summarizes the current status of the recent (5-year) clinical trials and describes contemporary research on pancreati...
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