Preoperative FOLFIRINOX for borderline resectable pancreatic cancer: Is radiation necessary in the modern era of chemotherapy?
Sunhee S. Kim BS
Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
Search for more papers by this authorCorresponding Author
Eric K. Nakakura MD, PhD
Department of Surgery, University of California San Francisco, San Francisco, California
Correspondence to: Eric K. Nakakura, MD, PhD, Department of Surgery, University of California San Francisco, San Francisco, CA. Fax: +1-415-353-9695. E-mail: [email protected]
Correspondence to: Andrew H. Ko, MD, Division of Hematology/Oncology, University of California San Francisco, 550 16th Street, 6th floor, Box 3211, San Francisco, CA 94143. Fax: +1-415-353-7779. E-mail: [email protected]
Search for more papers by this authorZhen J. Wang MD
Department of Radiology, University of California San Francisco, San Francisco, California
Search for more papers by this authorGrace E. Kim MD
Department of Pathology, University of California San Francisco, San Francisco, California
Search for more papers by this authorCarlos U. Corvera MD
Department of Surgery, University of California San Francisco, San Francisco, California
Search for more papers by this authorHobart W. Harris MD, MPH
Department of Surgery, University of California San Francisco, San Francisco, California
Search for more papers by this authorKimberly S. Kirkwood MD
Department of Surgery, University of California San Francisco, San Francisco, California
Search for more papers by this authorRyutaro Hirose MD
Department of Surgery, University of California San Francisco, San Francisco, California
Search for more papers by this authorMargaret A. Tempero MD
Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
Search for more papers by this authorCorresponding Author
Andrew H. Ko MD
Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
Correspondence to: Eric K. Nakakura, MD, PhD, Department of Surgery, University of California San Francisco, San Francisco, CA. Fax: +1-415-353-9695. E-mail: [email protected]
Correspondence to: Andrew H. Ko, MD, Division of Hematology/Oncology, University of California San Francisco, 550 16th Street, 6th floor, Box 3211, San Francisco, CA 94143. Fax: +1-415-353-7779. E-mail: [email protected]
Search for more papers by this authorSunhee S. Kim BS
Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
Search for more papers by this authorCorresponding Author
Eric K. Nakakura MD, PhD
Department of Surgery, University of California San Francisco, San Francisco, California
Correspondence to: Eric K. Nakakura, MD, PhD, Department of Surgery, University of California San Francisco, San Francisco, CA. Fax: +1-415-353-9695. E-mail: [email protected]
Correspondence to: Andrew H. Ko, MD, Division of Hematology/Oncology, University of California San Francisco, 550 16th Street, 6th floor, Box 3211, San Francisco, CA 94143. Fax: +1-415-353-7779. E-mail: [email protected]
Search for more papers by this authorZhen J. Wang MD
Department of Radiology, University of California San Francisco, San Francisco, California
Search for more papers by this authorGrace E. Kim MD
Department of Pathology, University of California San Francisco, San Francisco, California
Search for more papers by this authorCarlos U. Corvera MD
Department of Surgery, University of California San Francisco, San Francisco, California
Search for more papers by this authorHobart W. Harris MD, MPH
Department of Surgery, University of California San Francisco, San Francisco, California
Search for more papers by this authorKimberly S. Kirkwood MD
Department of Surgery, University of California San Francisco, San Francisco, California
Search for more papers by this authorRyutaro Hirose MD
Department of Surgery, University of California San Francisco, San Francisco, California
Search for more papers by this authorMargaret A. Tempero MD
Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
Search for more papers by this authorCorresponding Author
Andrew H. Ko MD
Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
Correspondence to: Eric K. Nakakura, MD, PhD, Department of Surgery, University of California San Francisco, San Francisco, CA. Fax: +1-415-353-9695. E-mail: [email protected]
Correspondence to: Andrew H. Ko, MD, Division of Hematology/Oncology, University of California San Francisco, 550 16th Street, 6th floor, Box 3211, San Francisco, CA 94143. Fax: +1-415-353-7779. E-mail: [email protected]
Search for more papers by this authorAbstract
Background
No consensus exists regarding the optimal neoadjuvant treatment paradigm for patients with borderline resectable pancreatic cancer (BRPC), including the respective roles of chemotherapy and radiation.
Methods
We performed a retrospective analysis, including detailed pathologic and radiologic review, of pancreatic cancer patients undergoing FOLFIRINOX, with or without radiation therapy (RT), prior to surgical resection at a high-volume academic center over a 4-year period.
Results
Of 26 patients meeting inclusion criteria, 22 (84.6%) received FOLFIRINOX alone without RT (median number of treatment cycles = 9). The majority of patients met formal radiographic criteria for BRPC, with the superior mesenteric vein representing the most common vessel involved. R0 resection rate was 90.9%, with 12 patients (54.5%) requiring vascular reconstruction. Treatment response was classified as moderate or marked in 16 patients (72.7%) according to the College of American Pathologists grading system. Estimated median disease-free and overall survival rates are 22.6 months and not reached (NR), respectively.
Conclusions
This is one of the largest series to describe the use of neoadjuvant FOLFIRINOX, without radiation therapy, in patients with BRPC undergoing surgical resection. Given the high R0 resection rates and favorable clinical outcomes with chemotherapy alone, this strategy should be further assessed in prospective study design. J. Surg. Oncol. 2016;114:587–596. © 2016 Wiley Periodicals, Inc.
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