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Wijetunga AR, Chua TC, Nahm CB, et al. Survival in borderline resectable and locally advanced pancreatic cancer is determined by the duration and response of neoadjuvant therapy. Eur J Surg Oncol. 2021;47(10):2543-2550doi: 10.1016/j.ejso.2021.04.005.
Wijetunga, A. R., Chua, T. C., Nahm, C. B., Pavlakis, N., Clarke, S., Chan, D. L., Diakos, C., Maloney, S., Ashrafi-Zadeh, A., Kneebone, A., Hruby, G., Jamieson, N. B., Gill, A., Mittal, A., & Samra, J. S. (2021). Survival in borderline resectable and locally advanced pancreatic cancer is determined by the duration and response of neoadjuvant therapy. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 47(10), 2543-2550. https://doi.org/10.1016/j.ejso.2021.04.005
Wijetunga, Asanka R, et al. "Survival in borderline resectable and locally advanced pancreatic cancer is determined by the duration and response of neoadjuvant therapy." European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology vol. 47,10 (2021): 2543-2550. doi: https://doi.org/10.1016/j.ejso.2021.04.005
Wijetunga AR, Chua TC, Nahm CB, Pavlakis N, Clarke S, Chan DL, Diakos C, Maloney S, Ashrafi-Zadeh A, Kneebone A, Hruby G, Jamieson NB, Gill A, Mittal A, Samra JS. Survival in borderline resectable and locally advanced pancreatic cancer is determined by the duration and response of neoadjuvant therapy. Eur J Surg Oncol. 2021 Oct;47(10):2543-2550. doi: 10.1016/j.ejso.2021.04.005. Epub 2021 Apr 30. PMID: 33952409.
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Eur J Surg Oncol. 2021 Oct;47(10):2543-2550. doi: 10.1016/j.ejso.2021.04.005. Epub 2021 Apr 30.

Survival in borderline resectable and locally advanced pancreatic cancer is determined by the duration and response of neoadjuvant therapy.

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

Asanka R Wijetunga, Terence C Chua, Christopher B Nahm, Nick Pavlakis, Stephen Clarke, David L Chan, Connie Diakos, Sarah Maloney, Amir Ashrafi-Zadeh, Andrew Kneebone, George Hruby, Nigel B Jamieson, Anthony Gill, Anubhav Mittal, Jaswinder S Samra

Affiliations

  1. Sydney Medical School, The University of Sydney, Sydney, Australia. Electronic address: [email protected].
  2. School of Medicine, Griffith University, Gold Coast, QLD, Australia; Department of Surgery, QE II Jubilee Hospital, Brisbane, QLD, Australia.
  3. Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Hepatopancreatobiliary Surgery, Westmead Hospital, Sydney, NSW, Australia.
  4. Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Australian Pancreatic Centre, St Leonards, Sydney, NSW, Australia.
  5. Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Australian Pancreatic Centre, St Leonards, Sydney, NSW, Australia.
  6. Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.
  7. Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, NSW, Australia.
  8. Australian Pancreatic Centre, St Leonards, Sydney, NSW, Australia; Department of Radiation Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.
  9. Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom.
  10. Sydney Medical School, The University of Sydney, Sydney, Australia; Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia.
  11. Sydney Medical School, The University of Sydney, Sydney, Australia; Australian Pancreatic Centre, St Leonards, Sydney, NSW, Australia; Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, NSW, Australia.

PMID: 33952409 DOI: 10.1016/j.ejso.2021.04.005

Abstract

BACKGROUND: Pancreatic cancer is the 8th commonest cancer and the 5th commonest cause of cancer-related death in Australia, with a 9% average 5-year survival. This study aims to investigate the effects of neoadjuvant treatment on overall survival (OS) and recurrence-free survival (RFS) in borderline resectable (BRPC) and locally advanced (LAPC) pancreatic adenocarcinoma followed by curative resection.

MATERIALS AND METHODS: Prospectively-collected demographic, medical, surgical and pathological data of patients with BRPC and LAPC treated with both neoadjuvant therapy (NAT) and surgery at a single tertiary referral centre in Australia were reviewed and analysed.

RESULTS: Between 2012 and 2018, 60 patients, 34 with BRPC and 26 with LAPC, were treated with NAT followed by curative resection. The commonest neoadjuvant chemotherapy regimens were Gemcitabine + Abraxane (51.7%) and FOLFIRINOX (35.0%), with 48.3% of patients additionally receiving neoadjuvant radiotherapy. Median RFS was 30 months and median OS was 35 months. On multivariable analysis, inferior OS was predicted by enlarged loco-regional lymph nodes on initial computed tomography (p = 0.032), larger tumour size post-NAT (p = 0.006) and Common Terminology Criteria for Adverse Events post-NAT toxicity greater than grade 2 (p = 0.015). LAPC patients received more neoadjuvant chemotherapy (p = 0.008) and radiotherapy (p = 0.021) than BRPC and achieved a superior pathological response (p = 0.010).

CONCLUSION: Patients who respond to NAT likely have a favourable disease biology and will progress well following resection. It is these patients who should be selected for more aggressive upfront management, and those with resistant disease should be spared from high-risk surgery.

Copyright © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Keywords: Borderline resectable; Chemotherapy; Locally advanced; Neoadjuvant; Pancreas; Surgery

Conflict of interest statement

Declaration of competing interest None.

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