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Total Neoadjuvant Therapy for Operable Pancreatic Cancer. Ann Surg Oncol 2021 Apr;28(4):2246-2256

Date

10/02/2020

Pubmed ID

33000372

DOI

10.1245/s10434-020-09149-3

Scopus ID

2-s2.0-85091728559   13 Citations

Abstract

BACKGROUND: Overall survival (OS) for operable pancreatic cancer (PC) is optimized when 4-6A months of nonsurgical therapy is combined with pancreatectomy. Because surgery renders the delivery of postoperative therapy uncertain, total neoadjuvant therapy (TNT) is gaining popularity.

METHODS: We performed a retrospective cohort study of patients with operable PC and compared TNT with shorter course neoadjuvant therapy (SNT). Primary outcomes of interest included completion of neoadjuvant therapy (NT) and resection of the primary tumor, receipt of 5A months of nonsurgical therapy, and median OS.

RESULTS: We reviewed 541 consecutive patients from 2009 to 2019 including 226 (42%) with resectable PC and 315 (58%) with borderline resectable (BLR) PC. The median age was 66A years (IQR [59, 72]), and 260 (48%) patients were female. TNT was administered to 89 (16%) patients and SNT was administered to 452 (84%). Both groups were equally likely to complete intended NT and surgery (pa??=a??0.90). Patients who received TNT and surgical resection were more likely to have a complete pathologic response (8% vs 4%, pa??<a??0.01) and were more likely to receive at least 5A months of nonsurgical therapy (67% vs 45%, pa??<a??0.01). The median OS was 26A months [IQR (15, 57)]; not reached among patients treated with TNT, and 25A months [IQR (15, 56)] among patients treated with SNT (pa??=a??0.19).

CONCLUSIONS: TNT ensures the delivery of intended systemic therapy prior to a complicated operation without decreasing the chance of successful surgery; a window of operability was not lost. Patients who can tolerate SNT will likely benefit from TNT.

Author List

Kim RY, Christians KK, Aldakkak M, Clarke CN, George B, Kamgar M, Khan AH, Kulkarni N, Hall WA, Erickson BA, Evans DB, Tsai S

Authors

Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Callisia N. Clarke MD Associate Professor in the Surgery department at Medical College of Wisconsin
Beth A. Erickson MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Ben George MD Associate Professor in the Medicine department at Medical College of Wisconsin
William Adrian Hall MD Associate Professor in the Radiation Oncology department at Medical College of Wisconsin
Mandana Kamgar MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Susan Tsai MD Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Antineoplastic Combined Chemotherapy Protocols
Female
Humans
Male
Neoadjuvant Therapy
Pancreatectomy
Pancreatic Neoplasms
Retrospective Studies
Treatment Outcome