Added Value of Radiotherapy Following Neoadjuvant FOLFIRINOX for Resectable and Borderline Resectable Pancreatic Cancer: A Systematic Review and Meta-Analysis

Published on Jun 17, 2021in Annals of Surgical Oncology5.344
· DOI :10.1245/S10434-021-10276-8
Alice C. Wei2
Estimated H-index: 2
(MSK: Memorial Sloan Kettering Cancer Center)
BACKGROUND The added value of radiotherapy following neoadjuvant FOLFIRINOX chemotherapy in patients with resectable or borderline resectable pancreatic cancer ((B)RPC) is unclear. The objective of this meta-analysis was to compare outcomes of patients who received neoadjuvant FOLFIRINOX alone or combined with radiotherapy. METHODS A systematic literature search was performed in Embase, Medline (ovidSP), Web of Science, Scopus, Cochrane, and Google Scholar. The primary endpoint was pooled median overall survival (OS). Secondary endpoints included resection rate, R0 resection rate, and other pathologic outcomes. RESULTS We included 512 patients with (B)RPC from 15 studies, of which 7 were prospective nonrandomized studies. In total, 351 patients (68.6%) were treated with FOLFIRINOX alone (8 studies) and 161 patients (31.4%) were treated with FOLFIRINOX and radiotherapy (7 studies). The pooled estimated median OS was 21.6 months (range 18.4-34.0 months) for FOLFIRINOX alone and 22.4 months (range 11.0-37.7 months) for FOLFIRINOX with radiotherapy. The pooled resection rate was similar (71.9% vs. 63.1%, p = 0.43) and the pooled R0 resection rate was higher for FOLFIRINOX with radiotherapy (88.0% vs. 97.6%, p = 0.045). Other pathological outcomes (ypN0, pathologic complete response, perineural invasion) were comparable. CONCLUSIONS In this meta-analysis, radiotherapy following neoadjuvant FOLFIRINOX was associated with an improved R0 resection rate as compared with neoadjuvant FOLFIRINOX alone, but a difference in survival could not be demonstrated. Randomized trials are needed to determine the added value of radiotherapy following neoadjuvant FOLFIRINOX in patients with (B)PRC.
#1Quisette P Janssen (EUR: Erasmus University Rotterdam)H-Index: 4
#2J.L. van Dam (EUR: Erasmus University Rotterdam)H-Index: 1
Last. B. Groot Koerkamp (EUR: Erasmus University Rotterdam)H-Index: 18
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BACKGROUND Neoadjuvant therapy has several potential advantages over upfront surgery in patients with localized pancreatic cancer; more patients receive systemic treatment, fewer patients undergo futile surgery, and R0 resection rates are higher, thereby possibly improving overall survival (OS). Two recent randomized trials have suggested benefit of neoadjuvant chemoradiotherapy over upfront surgery, both including single-agent chemotherapy regimens. Potentially, the multi-agent FOLFIRINOX regim...
#1Changhoon YooH-Index: 24
#2Inhwan HwangH-Index: 4
Last. Baek-Yeol Ryoo (UOU: University of Ulsan)H-Index: 34
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Background Despite the scarcity of data based on randomized trials, FOLFIRINOX is widely used in the management of borderline resectable pancreatic cancer (BRPC) and locally advanced unresectable pancreatic cancer (LAPC). We investigated the clinical outcomes of neoadjuvant FOLFIRINOX in patients with BRPC and LAPC. Methods This single-center retrospective analysis included a total of 199 consecutive patients with BRPC or LAPC who received conventional or modified FOLFIRINOX between February 201...
#1Leila Tchelebi (Penn State Cancer Institute)H-Index: 10
#2Eric J. Lehrer (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 15
Last. Nicholas G. Zaorsky (PSU: Pennsylvania State University)H-Index: 30
view all 7 authors...
BACKGROUND: The goal of this study was to characterize the efficacy and safety of stereotactic body radiation therapy (SBRT) versus conventionally fractionated radiation therapy with concurrent chemotherapy (CFRT) for the definitive treatment of locally advanced pancreatic cancer. The primary outcome measure was efficacy, defined by 2-year overall survival (OS). Secondary outcomes were incidence of any grade 3/4 toxicity and 1-year OS. METHODS: A PICOS/PRISMA/MOOSE selection protocol was used to...
#1J. MedranoH-Index: 1
#2Jonathan GarnierH-Index: 6
Last. Olivier Turrini (AMU: Aix-Marseille University)H-Index: 37
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Abstract Background/objective We evaluated the usefulness of the 2017 definition of borderline pancreatic ductal adenocarcinoma (BR-PDAC) in fit patients (performance status 0–1) based on anatomical (A) and biological dimensions (B). Methods From 2011 to 2018, 139 resected patients with BR-PDAC according to the 2017 definition were included: 18 patients underwent upfront pancreatectomy (CA 19-9 > 500 U/mL and/or regional lymph node metastasis; BR-B group), and 121 received FOLFIRINOX (FX) induct...
#1Eva Versteijne (UvA: University of Amsterdam)H-Index: 11
#2Mustafa Suker (EUR: Erasmus University Rotterdam)H-Index: 13
Last. Geertjan van Tienhoven (UvA: University of Amsterdam)H-Index: 33
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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...
#1Jordan M. Cloyd (The Ohio State University Wexner Medical Center)H-Index: 22
#2Aslam Ejaz (The Ohio State University Wexner Medical Center)H-Index: 35
Last. Allan Tsung (The Ohio State University Wexner Medical Center)H-Index: 74
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BACKGROUND: Neoadjuvant therapy (NT) is increasingly utilized for patients with pancreatic ductal adenocarcinoma (PDAC) but the nationwide incidence and long-term prognosis of a pathologic complete response (pCR) remains poorly understood. METHODS: Patients with localized PDAC and known cT and pT stage who received NT prior to pancreatectomy from 2004 to 2016 were identified using the National Cancer Database. The clinicopathologic characteristics and long-term outcomes of patients who did and d...
#1Azfar Neyaz (Harvard University)H-Index: 10
#2Elisabeth S Tabb (Harvard University)H-Index: 1
Last. Vikram DeshpandeH-Index: 122
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INTRODUCTION: In the adjuvant setting, when compared to gemcitabine, patients with pancreatic ductal adenocarcinoma (PDAC) treated with FOLFIRINOX show superior survival. Herein, we quantitatively assess pathologic tumor response to chemoradiation in pancreatectomy specimen and reassess guidelines for tumor regression grading. METHODS: We evaluated 92 patients with borderline resectable/locally advanced PDAC following pancreatectomy and neoadjuvant treatment with FOLFIRINOX and radiation. Demogr...
#1Michael Xiang (Stanford University)H-Index: 14
#2Gregory M. Heestand (Stanford University)H-Index: 8
Last. Erqi L. Pollom (Stanford University)H-Index: 21
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Abstract Background and purpose The optimal neoadjuvant approach in patients with resectable pancreas cancer is unclear. We investigated outcomes after preoperative chemotherapy alone, chemotherapy with conventionally-fractionated radiation (CFRT), or chemotherapy with stereotactic body radiotherapy (SBRT). Materials and methods The NCDB was queried for patients with resectable pancreatic adenocarcinoma (pretreatment stage T1-3, N0-1, M0) who received preoperative, multiagent chemotherapy and de...
#1Nguyen H. Tran (UM: University of Michigan)H-Index: 2
#2Vaibhav Sahai (UM: University of Michigan)H-Index: 25
Last. Mark M. Zalupski (UM: University of Michigan)H-Index: 51
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Abstract Background Preoperative therapy in borderline resectable pancreatic cancer (BRPC) is intended to increase R0 resection rates. An optimal approach in BRPC is yet to be defined. Methods Patients with BRPC, confirmed adenocarcinoma, performance status 1 and adequate organ function enrolled in a single-institution, phase II trial. Patients received FOLFIRINOX x 6 cycles, then radiation therapy (50 Gy in 25 fractions) concurrent with fixed-dose rate (FDR) gemcitabine (1 g/m2 over 100 minutes...
#1Rebecca L. Siegel (ACS: American Cancer Society)H-Index: 68
#2Kimberly D. Miller (ACS: American Cancer Society)H-Index: 29
Last. Ahmedin Jemal (ACS: American Cancer Society)H-Index: 139
view all 3 authors...
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2016) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2017) were collected by the National Center for Health Statis...
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