Rombouts Steffi J, Walma Marieke S, Vogel Jantien A, van Rijssen Lennart B, Wilmink Johanna W, Mohammad Nadia Haj, van Santvoort Hjalmar C, Molenaar I Quintus, Besselink Marc G
Department of Surgery, University Medical Centre Utrecht Cancer Center, Utrecht, The Netherlands.
Department of Surgery, G4-196, Academic Medical Centre, Amsterdam, The Netherlands.
Ann Surg Oncol. 2016 Dec;23(13):4352-4360. doi: 10.1245/s10434-016-5373-2. Epub 2016 Jul 1.
FOLFIRINOX prolongs survival in patients with metastatic pancreatic cancer and may also benefit patients with locally advanced pancreatic cancer (LAPC). Furthermore, it may downstage a proportion of LAPC into (borderline) resectable disease, however data are lacking. This review assessed outcomes after FOLFIRINOX-based therapy in LAPC.
The PubMed, EMBASE and Cochrane library databases were systematically searched for studies published to 31 August 2015. Primary outcome was the (R0) resection rate.
Fourteen studies involving 365 patients with LAPC were included; three studies administered a modified FOLFIRINOX regimen. Of all patients, 57 % (n = 208) received radiotherapy. The pooled resection rate was 28 % (n = 103, 77 % R0), with a perioperative mortality of 3 % (n = 2), and median overall survival ranged from 8.9 to 25.0 months. Survival data after resection were scarce, with only one study reporting a median overall survival of 24.9 months in 28 patients. A complete pathologic response was found in 6 of 85 (7 %) resected specimens. Dose reductions were described in up to 65 % of patients, grade 3-4 toxicity occurred in 23 % (n = 51) of patients, and 2 % (n = 5) had to discontinue treatment. Data of patients treated solely with FOLFIRINOX, without additional radiotherapy, were available from 292 patients: resection rate was 12 % (n = 29, 70 % R0), with 15.7 months median overall survival and 19 % (n = 34) grade 3-4 toxicity.
Outcomes after FOLFIRINOX-based therapy in patients with LAPC seem very promising but further prospective studies are needed, especially with regard to survival after resection.
FOLFIRINOX方案可延长转移性胰腺癌患者的生存期，对局部晚期胰腺癌（LAPC）患者可能也有益处。此外，该方案可能使一部分LAPC患者降期为（临界）可切除疾病，但目前缺乏相关数据。本综述评估了LAPC患者接受基于FOLFIRINOX方案治疗后的结局。
系统检索PubMed、EMBASE和Cochrane图书馆数据库中截至2015年8月31日发表的研究。主要结局为（R0）切除率。
纳入了14项研究，共365例LAPC患者；3项研究采用改良的FOLFIRINOX方案。所有患者中，57%（n = 208）接受了放疗。汇总切除率为28%（n = 103，R0切除率为77%），围手术期死亡率为3%（n = 2），中位总生存期为8.9至25.0个月。切除术后的生存数据较少，仅有1项研究报告28例患者的中位总生存期为24.9个月。85例切除标本中有6例（7%）出现完全病理缓解。高达65%的患者出现剂量减少，23%（n = 51）的患者发生3 - 4级毒性反应，2%（n = 5）的患者不得不停止治疗。292例仅接受FOLFIRINOX治疗而未接受额外放疗的患者的数据如下：切除率为12%（n = 29，R0切除率为70%），中位总生存期为15.7个月，3 - 4级毒性反应发生率为19%（n = 34）。
LAPC患者接受基于FOLFIRINOX方案治疗后的结局似乎很有前景，但需要进一步的前瞻性研究，尤其是关于切除术后的生存情况。
