Lee Jongchan, Lee Jong-Chan, Gromski Mark A, Kim Hyoung Woo, Kim Jinwon, Kim Jaihwan, Hwang Jin-Hyeok
Department of Internal Medicine, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Internal Medicine, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Medicine (Baltimore). 2018 Dec;97(50):e13592. doi: 10.1097/MD.0000000000013592.
Systemic chemotherapy or chemoradiotherapy is the initial primary option for patients with locally advanced pancreatic cancer (LAPC). This study analyzed the effect of FOLFIRINOX and assessed the factors influencing conversion to surgical resectability for LAPC.Sixty-four patients with LAPC who received FOLFIRINOX as initial chemotherapy were enrolled retrospectively. Demographic characteristics, tumor status, interval/dosage/cumulative relative dose intensity (cRDI) of FOLFIRINOX, conversion to resection, and clinical outcomes were reviewed and factors associated with conversion to resectability after FOLFIRINOX were analyzed.After administration of FOLFIRINOX (median 9 cycles, 70% of cRDI), the median patient overall survival (OS) was 17.0 months. Fifteen of 64 patients underwent surgery and R0 resection was achieved in 11 patients. During a median follow-up time of 9.4 months after resection, cumulative recurrence rate was 28.5% at 18 months after resection. The estimated median OS was significantly longer for the resected group (>40 months vs 13 months). There were no statistical differences between the resected and non-resected groups in terms of baseline characteristics, tumor status and hematologic adverse effects. The patients who received standard dose of FOLFIRINOX had higher probability of subsequent resection compared with patients who received reduced dose, although cRDIs did not differ between groups.FOLFIRINOX is an active regimen in patients with LAPC, given acceptable resection rates and promising R0 resection rates. Additionally, our data demonstrate it is advantageous for obtaining resectability to administer FOLFIRINOX without dose reduction.
全身化疗或放化疗是局部晚期胰腺癌（LAPC）患者的初始主要治疗选择。本研究分析了FOLFIRINOX方案的疗效，并评估了影响LAPC患者转化为可手术切除的因素。对64例接受FOLFIRINOX作为初始化疗的LAPC患者进行了回顾性研究。回顾了患者的人口统计学特征、肿瘤状态、FOLFIRINOX方案的疗程/剂量/累积相对剂量强度（cRDI）、转化为手术切除的情况以及临床结局，并分析了FOLFIRINOX方案后与转化为可切除性相关的因素。给予FOLFIRINOX方案（中位疗程9个周期，cRDI的70%）后，患者的中位总生存期（OS）为17.0个月。64例患者中有15例接受了手术，11例实现了R0切除。在切除术后的中位随访时间9.4个月内，术后18个月的累积复发率为28.5%。切除组的估计中位OS明显更长（>40个月对13个月）。切除组和未切除组在基线特征、肿瘤状态和血液学不良反应方面无统计学差异。接受标准剂量FOLFIRINOX方案的患者相比接受减量方案的患者后续切除的可能性更高，尽管两组之间的cRDI没有差异。FOLFIRINOX方案对LAPC患者是一种有效的治疗方案，其可接受的切除率和良好的R0切除率令人满意。此外，我们的数据表明，不减量给予FOLFIRINOX方案有利于获得可切除性。
