Neoadjuvant chemoradiation may be associated with improved pathologic response in pancreatic cancer

Am J Surg. 2021 Mar;221(3):500-504. doi: 10.1016/j.amjsurg.2020.11.035. Epub 2020 Nov 19.

Abstract

Background: Neoadjuvant therapy is increasingly utilized in the management of pancreatic adenocarcinoma. The type of neoadjuvant therapy and its effect on pathologic response remains understudied.

Methods: A retrospective review was performed on patients who underwent neoadjuvant therapy followed by pancreatectomy. Multivariable regressions were used to determine associations between neoadjuvant therapy regimens and pathologic response.

Results: Seventy-five patients with pathologic responses available for review received FOLFIRINOX (61%) or gemcitabine with nab-paclitaxel (39%). Demographics, histologic differentiation, and utilization of chemoradiation were similar between the groups. Multivariable logistic regression demonstrated that chemoradiation was associated with an increased likelihood of a complete or near-complete pathologic response and a decreased rate of lymphovascular invasion and lymph node positivity. Neither chemotherapy regimen nor number of cycles administered were associated with pathologic response.

Conclusions: Neoadjuvant chemoradiation may be associated with complete or near-complete pathologic response regardless of chemotherapy regimen in pancreatic cancer patients.

Keywords: Neoadjuvant therapy; Pancreatic cancer; Pathologic response.

MeSH terms

  • Adenocarcinoma / pathology
  • Adenocarcinoma / therapy*
  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Chemoradiotherapy*
  • Deoxycytidine / analogs & derivatives
  • Deoxycytidine / therapeutic use
  • Female
  • Fluorouracil / therapeutic use
  • Gemcitabine
  • Humans
  • Irinotecan / therapeutic use
  • Leucovorin / therapeutic use
  • Logistic Models
  • Male
  • Middle Aged
  • Neoadjuvant Therapy*
  • Oxaliplatin / therapeutic use
  • Paclitaxel / therapeutic use
  • Pancreatectomy*
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / therapy*
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Antineoplastic Agents
  • folfirinox
  • Oxaliplatin
  • Deoxycytidine
  • Irinotecan
  • Paclitaxel
  • Leucovorin
  • Fluorouracil
  • Gemcitabine