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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Autores: 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
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p15116
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/15116
Access Level:acceso abierto
Palabra clave:borderline resectable
locally advanced unresectable
pancreatic cancer
neoadjuvant therapy
FOLFIRINOX
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spelling Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centreRosello, SusanaPizzo, ClaudioHuerta, MarisolMunoz, ElenaAliaga, RobertoVera, AlmudenaAlfaro-Cervello, ClaraJorda, EstherGarces-Albir, MarinaRoda, DesamparadosDorcaratto, DimitriTarazona, NoeliaTorondel, SergioGuijarro, JorgeSanchiz, VicenteGambardella, ValentinaFleitas-Kanonnikoff, TaniaLluch, PalomaPascual, IsabelFerrandez, AntonioSabater, LuisCervantes, Andresborderline resectablelocally advanced unresectablepancreatic cancerneoadjuvant therapyFOLFIRINOXINTRODUCTION: 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.ELSEVIER2020info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/15116ESMO OpenISSN: 20597029reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p151162026-06-07T16:35:31Z
dc.title.none.fl_str_mv Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centre
title Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centre
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
title_short 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_sort Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centre
dc.creator.none.fl_str_mv 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 Rosello, Susana
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
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
dc.subject.none.fl_str_mv borderline resectable
locally advanced unresectable
pancreatic cancer
neoadjuvant therapy
FOLFIRINOX
topic borderline resectable
locally advanced unresectable
pancreatic cancer
neoadjuvant therapy
FOLFIRINOX
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.
publishDate 2020
dc.date.none.fl_str_mv 2020
dc.type.none.fl_str_mv info:eu-repo/semantics/article
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format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/15116
url https://incliva.portalinvestigacion.com/publicaciones/15116
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv ELSEVIER
publisher.none.fl_str_mv ELSEVIER
dc.source.none.fl_str_mv ESMO Open
ISSN: 20597029
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
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