Kizy Scott, Altman Ariella M, Wirth Keith M, Marmor Schelomo, Hui Jane Y C, Tuttle Todd M, Lou Emil, Amin Khalid, Denbo Jason W, Jensen Eric H
Division of Surgical Oncology, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Division of Hematology and Oncology, Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA.
Hepatobiliary Surg Nutr. 2020 Jun;9(3):296-303. doi: 10.21037/hbsn.2019.04.17.
The utility of neoadjuvant treatment for resectable pancreas cancer is yet to be determined, but has commonly included chemoradiation. We evaluated outcomes in patients with radiographically resectable pancreatic adenocarcinoma treated with neoadjuvant chemotherapy without chemoradiation.
A retrospective review of patients in our institutional pancreatic cancer registry was performed, which identified 36 patients who received neoadjuvant chemotherapy alone for resectable pancreatic adenocarcinoma between 2012 and 2016.
Median age at diagnosis was 66.3 years. Chemotherapy regimens included gemcitabine (n=17), gemcitabine/nab-paclitaxel (n=8), or 5-FU/leucovorin/irinotecan/oxaliplatin (FOLFIRINOX) (n=11). Surgical resection was performed in 69% of patients (n=25), with an R0 resection rate of 92% (n=23 patients). During chemotherapy, distant disease became apparent in 19% of patients (n=7), while no patients had evidence of local progression. Resection rates were similar between chemotherapy regimens (single agent =59%, multiple agent =79%). Median overall survival for all patients who received neoadjuvant chemotherapy was 30.3 and 34.4 months for those who underwent surgical resection. There was no difference in median survival for patients treated with gemcitabine (31.3 months) or multi-agent chemotherapy (29.7 months).
A short course of neoadjuvant chemotherapy without chemoradiation may improve patient selection prior to surgical resection for pancreas cancer. Further, local disease progression did not limit surgical resection in this small series.
新辅助治疗对可切除胰腺癌的效用尚未确定，但通常包括放化疗。我们评估了接受无放化疗的新辅助化疗的影像学可切除胰腺腺癌患者的预后。
对我们机构胰腺癌登记处的患者进行回顾性研究，确定了2012年至2016年间36例因可切除胰腺腺癌仅接受新辅助化疗的患者。
诊断时的中位年龄为66.3岁。化疗方案包括吉西他滨（n = 17）、吉西他滨/白蛋白结合型紫杉醇（n = 8）或氟尿嘧啶/亚叶酸钙/伊立替康/奥沙利铂（FOLFIRINOX）（n = 11）。69%的患者（n = 25）接受了手术切除，R0切除率为92%（n = 23例患者）。化疗期间，19%的患者（n = 7）出现远处转移，而无患者有局部进展的证据。不同化疗方案的切除率相似（单药方案 = 59%，联合用药方案 = 79%）。所有接受新辅助化疗患者的中位总生存期为30.3个月，接受手术切除患者的中位总生存期为34.4个月。接受吉西他滨治疗的患者（31.3个月）和接受联合化疗的患者（29.7个月）的中位生存期无差异。
短期无放化疗的新辅助化疗可能会改善胰腺癌手术切除前的患者选择。此外，在这个小样本系列中，局部疾病进展并未限制手术切除。
