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McClaine RJ, Lowy AM, Sussman JJ, et al. Neoadjuvant therapy may lead to successful surgical resection and improved survival in patients with borderline resectable pancreatic cancer

Department of Surgery, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45219, USA.
HPB (Impact Factor: 2.68). 02/2010; 12(1):73-9. DOI: 10.1111/j.1477-2574.2009.00136.x
Source: PubMed

ABSTRACT

Borderline resectable pancreatic cancers are technically amenable to surgical resection, but are associated with increased risk of locoregional recurrence. Patients with these tumours may be treated with neoadjuvant therapy in an attempt to improve margin-negative resection rates.
The University of Cincinnati Pancreatic Cancer Database was retrospectively reviewed. Borderline resectable disease was defined by the following radiographic criteria: (i) short segment occlusion of the superior mesenteric vein (SMV), portal vein (PV) or SMV/PV confluence; (ii) short segment hepatic artery encasement, or (iii) superior mesenteric artery/coeliac artery abutment of <180 degrees. Patients with resectable disease who had questionable metastatic disease or poor performance status were also included.
Twenty-nine patients met the criteria. Of these, 26 underwent a full course of neoadjuvant therapy. Twelve (46%) underwent surgical resection and 14 had tumour progression or were deemed unresectable at laparotomy. The most common neoadjuvant therapy regimen was gemcitabine-based chemotherapy alone (58%). Of those undergoing surgery, 67% had margin-negative (R0) resections and 42% required venous resection. Median survival was 15.5 months for unresected patients and 23.3 months for resected patients.
Borderline resectable pancreatic tumours can be treated neoadjuvantly, resulting in margin-negative resection and survival rates similar to those in initially resectable disease.

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    • "Median survival of all 18 patients was 15.6 months and median survival had not been reached among those patients who completed all therapy to include pancreatectomy. The University of Cincinnati reported a retrospective institutional series of 29 patients with borderline resectable disease treated with a variety of different regimens including cXRT alone, chemotherapy alone, and cXRT followed by chemotherapy[51]. Twenty-six (89%) of the 29 patients completed neoadjuvant therapy; disease progression during/after neoadjuvant therapy occurred in 14 (48%) of the 29 patients and 12 (41%) of the remaining 16 patients underwent successful surgery. "

    Full-text · Article · Jan 2016 · Journal of Cancer Therapy
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    • "Clinical management for patients with borderline resectable PDA is controversial. Recent data suggests neoadjuvant chemotherapy (NACT) or neoadjuvant chemoradiation (NACRT) prior to resection can facilitate disease downstaging, increase chance of R0 resection, reduce rates of locoregional occurrence, and ultimately lead to increases in overall survival[4,8910. The NCCN guidelines support neoadjuvant chemotherapy in borderline resectable PDA but do not provide therapeutic guidance. "

    Full-text · Article · Dec 2014
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    • "McClaine et al. reported a 46% rate of surgical resection in a cohort of 26 patients with borderline pancreatic adenocarcinoma who underwent neoadjuvant chemoradiotherapy; 67% of them had a margin free resection. Median survival for resected patients was 23.3 months vs. 15.5 months for non-resected cases [12]. These two studies included a different number of patients; however, the difference was statistically significant in both. "
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    ABSTRACT: Pancreatic cancer remains as one of the most aggressive human neoplasms, with overall poor survival rates. Radical surgery of the primary lesion is the best option for treatment. Borderline resectable pancreatic tumors (BRPT), defined as partial involvement of peripancreatic vasculature, may benefit from neoadjuvant therapy. We report on the first two BRPT cases treated with neoadjuvant chemoradiation at our institution. Preoperative CT and MRI demonstrated pancreatic tumors encasing the porto-mesenteric confluence suggestive of BRPT. Patients received neoadjuvant chemotherapy (gemcitabine/cisplatin), followed by radiochemotherapy. After treatment, follow-up images demonstrated tumor downsize, allowing for the tumors to be considered then as resectable. They underwent partial pancreatoduodenectomies (Whipple procedure). In case 1, histopathology revealed a complete, margin-free resection, whereas in case 2 there was a complete pathological response, with no evidence of residual tumor. According to the literature, our initial experience using neoadjuvant chemoradiotherapy on BRPT allowed us to downsize the tumor and, subsequently, to perform a curative surgery.
    Full-text · Article · Feb 2013 · World Journal of Surgical Oncology
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