Suker Mustafa, Nuyttens Joost J, Groot Koerkamp Bas, Eskens Ferry A L M, van Eijck Casper H J
Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
Department of Radiotherapy, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
J Surg Oncol. 2018 Nov;118(6):1021-1026. doi: 10.1002/jso.25233. Epub 2018 Sep 27.
One-third of the patients with pancreatic cancer present with locally advanced unresectable pancreatic cancer (LAPC). Our aim was to determine survival outcomes and toxicity after FOLFIRINOX (leucovorin, fluorouracil, irinotecan, and oxaliplatin) followed by radiotherapy (RT) in biopsy-proven patients with LAPC.
We analysed a cohort of biopsy-proven patients with LAPC, who were eligible for induction FOLFIRINOX (eight cycles) and subsequent RT (30 fractions, 60 Gy). Eligible patients underwent a staging laparoscopy to detect occult metastasis before the treatment. The primary outcome was overall survival (OS), and secondary outcomes were progression-free survival (PFS), treatment-related toxicity, and resection rate.
Forty-four patients were diagnosed with biopsy-proven LAPC. Twenty-five patients were eligible and all underwent staging laparoscopy before the treatment. In three (12%) patients occult metastases were found. Twenty-two patients started induction FOLFIRINOX, 17 (77%) completed all cycles. Seventeen (77%) patients were treated with subsequent RT, with 16 (94%) receiving the full dosage. Three (14%) patients underwent a radical resection after the treatment. Median OS was 15.4 months (95% confidence interval [CI], 10.0-20.7), median PFS was 11 months (95% CI, 7.7-14.4).
Median OS after FOLFIRINOX and RT was 15 months in patients with LAPC. Toxicity remains severe, however, most patients completed all eight scheduled cycles of FOLFIRINOX and RT.
三分之一的胰腺癌患者表现为局部晚期不可切除的胰腺癌（LAPC）。我们的目的是确定在经活检证实的LAPC患者中，接受FOLFIRINOX方案（亚叶酸钙、氟尿嘧啶、伊立替康和奥沙利铂）治疗后再进行放疗（RT）的生存结局和毒性。
我们分析了一组经活检证实的LAPC患者，这些患者符合诱导化疗FOLFIRINOX（8个周期）及后续放疗（30次分割，60 Gy）的条件。符合条件的患者在治疗前接受分期腹腔镜检查以检测隐匿性转移。主要结局是总生存期（OS），次要结局是无进展生存期（PFS）、治疗相关毒性和切除率。
44例患者经活检证实为LAPC。25例患者符合条件，均在治疗前接受了分期腹腔镜检查。3例（12%）患者发现隐匿性转移。22例患者开始诱导化疗FOLFIRINOX，17例（77%）完成了所有周期。17例（77%）患者接受了后续放疗，16例（94%）接受了全剂量放疗。3例（14%）患者在治疗后接受了根治性切除。中位OS为15.4个月（95%置信区间[CI]，10.0 - 20.7），中位PFS为11个月（95% CI，7.7 - 14.4）。
LAPC患者接受FOLFIRINOX和放疗后的中位OS为15个月。毒性仍然严重，然而，大多数患者完成了FOLFIRINOX和放疗的所有八个预定周期。
