Neoadjuvant therapy for patients with borderline resectable pancreatic cancer: A systematic review and meta-analysis of response and resection percentages |
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| Affiliation: | 1. Division of Pathology, Department of Laboratory Medicine, Karolinska Institute, Hälsovägen, 141 86 Stockholm, Sweden;2. Department of Pathology & Cytology, Karolinska University Hospital, Hälsovägen, 141 86 Stockholm, Sweden;3. Gastrocentrum, Karolinska Institute, Hälsovägen, 141 86 Stockholm, Sweden;4. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Hälsovägen, 141 86 Stockholm, Sweden;1. Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy;2. Department of Pancreatic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy;3. Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;4. Pancreato-Biliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy;5. Pancreatic Surgery, Humanitas University, Humanitas Clinical and Research Center, Milan, Italy;6. Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Milan, Italy;7. Department of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy;8. Onco-Hematology Department, Oncology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy;9. Department of Pancreatic Surgery, Vita-Salute San Raffaele University, Milan, Italy;10. Pathology Unit, Vita-Salute San Raffaele University, Milan, Italy;11. IRCCS Mario Negri Institute for Pharmacological Research, Milan, Italy;1. Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands;2. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA;3. Department of Hepatogastroenterology, Antoine Beclère Hospital, Assistance publique-Hôpitaux de Paris, Paris Sud University, Clamart, France;4. Department of Hematology–Oncology, Massachusetts General Hospital, Boston, MA, USA;5. Department of Radiation Oncology, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA;6. Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA;7. Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA;8. Department of Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA;9. Department of Medicine, Division of Medical Oncology, University of Kentucky–Markey Cancer Center, Lexington, KY, USA;10. Department of Medicine, The Royal Marsden National Health Service Foundation Trust, London and Surrey, UK;11. Department of Medical Oncology, Institut de Cancérologie de Lorraine and Lorraine University, Vandoeuvre-lès-Nancy, France;12. Department of Hematology, Medical Oncology, Hemostasis, Rheumatology and Infectious Diseases, Paracelsus Medical University of Salzburg, Salzburg, Austria;13. Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, Sorbonne Paris Cité, Paris Descartes University, Cancer Research Personalized Medicine (CARPEM), Paris, France;14. Department of Radiation Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA |
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| Abstract: | BackgroundWe systematically reviewed and performed a meta-analysis of the available data regarding neoadjuvant chemo- and/or radiotherapy with special emphasis on tumor response/progression rates, toxicities, and clinical benefit, i.e. resection probabilities and survival estimates.Methods and findingsTrials were identified by searching PUBMED, MEDLINE, and the Cochrane Central Register of Controlled Trials from 1966 to Feb 2015. A total of 18 studies (n = 959) were analyzed. the estimated fraction of patients with complete response was 2.8% (CI 0.8–4.7%) and with partial response 28.7% (CI 18.9%–38.5%). Stable disease was averaged to 45.9% (CI 32.9%–58.9%) in all patients and tumor progression under therapy occurred by estimation in 16.9% (CI 10.2%–23.6%) of the patients. The weighted frequency of those who underwent resection was 65.3% (CI 54.2%–76.5%), and the proportion of R0 resection amounted to 57.4% (CI 48.2%–66.5%). The weighted mean of median survival amounted to 17.9 months (range: 14.7–21.2 months) for the overall cohort of patients, 25.9 months (range: 21.1–30.7 months) for those who were resected, and 11.9 months (range: 10.4–13.5 months) for unresected patients.ConclusionsThe resection and R0 resection rates in the group of borderline resectable tumor patients after neoadjuvant therapy are similar to the resectable tumor patients, much higher than those in unresectable tumor patients. The survival estimates of borderline resectable tumor patients after neoadjuvant therapy were similar to resectable tumor patients. Patients with borderline resectable pancreatic cancer should be included in neoadjuvant protocols and subsequently be reevaluated for resection. How to find chemo-responsiveness before neoadjuvant chemotherapy so as to give individualized treatment is still an important issue. |
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| Keywords: | Neoadjuvant therapy Borderline resectable Pancreatic cancer Meta-analysis Resection rate Survival |
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