Neoadjuvant chemo-radiotherapy for patients with borderline resectable pancreatic cancer

A meta-analytical evaluation of prospective studies

Virginia Festa, Angelo Andriulli, Maria Rosaria Valvano, Generoso Uomo, Francesco Perri, Nicola Andriulli, Salvatore Corrao, Maurizio Koch

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Context For patients with borderline resectable pancreatic cancer, the benefit of neoadjuvant therapy remains to be defined. Objective We did a systematic search of the literature on this topic. Methods Prospective studies where chemotherapy with or without radiotherapy was given before surgery to patients with borderline resectable cancer, were analyzed by a metaanalytical approach. Main outcome measures Primary outcome was surgical exploration and resection rates; tumor response, therapy-induced toxicity, and survival were secondary outcomes. Data were expressed as weighted pooled proportions with 95% confidence intervals (95% CI). Results Ten studies with 182 participants were included. Following treatment, 69% of patients (95% CI: 56-80%) were brought to surgery and 80% (95% CI: 66-90%) of surgically-explored patients were resected. Eighty-three percent (95% CI: 74-90%) of resected specimens were deemed R0 resections. The weighted fractions of resected patients alive at 1 and 2 years were 61% (95% CI: 48-100%) and 44% (95% CI: 32-59%), respectively. At restaging following neoadjuvant therapy, weighted frequencies for complete/partial response were 16% (95% CI: 9-28%), 69% (95% CI: 60-76%) for stable disease, and 19% (95% CI: 13-25%) for progressive cancer. Treatmentrelated grade 3-4 toxicity was 32% (95% CI: 21-45%). Conclusion This meta-analysis shows that downstaging of the lesion following neoadjuvant therapies is uncommon for patients with borderline resectable pancreatic cancer. A clear benefit of this regimen could be to spare surgery to patients with progressive disease during the frame-time chemo-radiotherapy is being delivered.

Original languageEnglish
Pages (from-to)618-625
Number of pages8
JournalJournal of the Pancreas
Volume14
Issue number6
Publication statusPublished - 2013

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Pancreatic Neoplasms
Radiotherapy
Prospective Studies
Confidence Intervals
Neoadjuvant Therapy
Neoplasms
Meta-Analysis
Outcome Assessment (Health Care)
Drug Therapy
Survival
Therapeutics

Keywords

  • Drug therapy
  • Evidence-based medicine
  • Meta-analysis as topic
  • Neoadjuvant therapy
  • Pancreatic carcinoma
  • Pancreatic neoplasms
  • Radiotherapy

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Hepatology

Cite this

Neoadjuvant chemo-radiotherapy for patients with borderline resectable pancreatic cancer : A meta-analytical evaluation of prospective studies. / Festa, Virginia; Andriulli, Angelo; Valvano, Maria Rosaria; Uomo, Generoso; Perri, Francesco; Andriulli, Nicola; Corrao, Salvatore; Koch, Maurizio.

In: Journal of the Pancreas, Vol. 14, No. 6, 2013, p. 618-625.

Research output: Contribution to journalArticle

Festa, Virginia ; Andriulli, Angelo ; Valvano, Maria Rosaria ; Uomo, Generoso ; Perri, Francesco ; Andriulli, Nicola ; Corrao, Salvatore ; Koch, Maurizio. / Neoadjuvant chemo-radiotherapy for patients with borderline resectable pancreatic cancer : A meta-analytical evaluation of prospective studies. In: Journal of the Pancreas. 2013 ; Vol. 14, No. 6. pp. 618-625.
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abstract = "Context For patients with borderline resectable pancreatic cancer, the benefit of neoadjuvant therapy remains to be defined. Objective We did a systematic search of the literature on this topic. Methods Prospective studies where chemotherapy with or without radiotherapy was given before surgery to patients with borderline resectable cancer, were analyzed by a metaanalytical approach. Main outcome measures Primary outcome was surgical exploration and resection rates; tumor response, therapy-induced toxicity, and survival were secondary outcomes. Data were expressed as weighted pooled proportions with 95{\%} confidence intervals (95{\%} CI). Results Ten studies with 182 participants were included. Following treatment, 69{\%} of patients (95{\%} CI: 56-80{\%}) were brought to surgery and 80{\%} (95{\%} CI: 66-90{\%}) of surgically-explored patients were resected. Eighty-three percent (95{\%} CI: 74-90{\%}) of resected specimens were deemed R0 resections. The weighted fractions of resected patients alive at 1 and 2 years were 61{\%} (95{\%} CI: 48-100{\%}) and 44{\%} (95{\%} CI: 32-59{\%}), respectively. At restaging following neoadjuvant therapy, weighted frequencies for complete/partial response were 16{\%} (95{\%} CI: 9-28{\%}), 69{\%} (95{\%} CI: 60-76{\%}) for stable disease, and 19{\%} (95{\%} CI: 13-25{\%}) for progressive cancer. Treatmentrelated grade 3-4 toxicity was 32{\%} (95{\%} CI: 21-45{\%}). Conclusion This meta-analysis shows that downstaging of the lesion following neoadjuvant therapies is uncommon for patients with borderline resectable pancreatic cancer. A clear benefit of this regimen could be to spare surgery to patients with progressive disease during the frame-time chemo-radiotherapy is being delivered.",
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T1 - Neoadjuvant chemo-radiotherapy for patients with borderline resectable pancreatic cancer

T2 - A meta-analytical evaluation of prospective studies

AU - Festa, Virginia

AU - Andriulli, Angelo

AU - Valvano, Maria Rosaria

AU - Uomo, Generoso

AU - Perri, Francesco

AU - Andriulli, Nicola

AU - Corrao, Salvatore

AU - Koch, Maurizio

PY - 2013

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N2 - Context For patients with borderline resectable pancreatic cancer, the benefit of neoadjuvant therapy remains to be defined. Objective We did a systematic search of the literature on this topic. Methods Prospective studies where chemotherapy with or without radiotherapy was given before surgery to patients with borderline resectable cancer, were analyzed by a metaanalytical approach. Main outcome measures Primary outcome was surgical exploration and resection rates; tumor response, therapy-induced toxicity, and survival were secondary outcomes. Data were expressed as weighted pooled proportions with 95% confidence intervals (95% CI). Results Ten studies with 182 participants were included. Following treatment, 69% of patients (95% CI: 56-80%) were brought to surgery and 80% (95% CI: 66-90%) of surgically-explored patients were resected. Eighty-three percent (95% CI: 74-90%) of resected specimens were deemed R0 resections. The weighted fractions of resected patients alive at 1 and 2 years were 61% (95% CI: 48-100%) and 44% (95% CI: 32-59%), respectively. At restaging following neoadjuvant therapy, weighted frequencies for complete/partial response were 16% (95% CI: 9-28%), 69% (95% CI: 60-76%) for stable disease, and 19% (95% CI: 13-25%) for progressive cancer. Treatmentrelated grade 3-4 toxicity was 32% (95% CI: 21-45%). Conclusion This meta-analysis shows that downstaging of the lesion following neoadjuvant therapies is uncommon for patients with borderline resectable pancreatic cancer. A clear benefit of this regimen could be to spare surgery to patients with progressive disease during the frame-time chemo-radiotherapy is being delivered.

AB - Context For patients with borderline resectable pancreatic cancer, the benefit of neoadjuvant therapy remains to be defined. Objective We did a systematic search of the literature on this topic. Methods Prospective studies where chemotherapy with or without radiotherapy was given before surgery to patients with borderline resectable cancer, were analyzed by a metaanalytical approach. Main outcome measures Primary outcome was surgical exploration and resection rates; tumor response, therapy-induced toxicity, and survival were secondary outcomes. Data were expressed as weighted pooled proportions with 95% confidence intervals (95% CI). Results Ten studies with 182 participants were included. Following treatment, 69% of patients (95% CI: 56-80%) were brought to surgery and 80% (95% CI: 66-90%) of surgically-explored patients were resected. Eighty-three percent (95% CI: 74-90%) of resected specimens were deemed R0 resections. The weighted fractions of resected patients alive at 1 and 2 years were 61% (95% CI: 48-100%) and 44% (95% CI: 32-59%), respectively. At restaging following neoadjuvant therapy, weighted frequencies for complete/partial response were 16% (95% CI: 9-28%), 69% (95% CI: 60-76%) for stable disease, and 19% (95% CI: 13-25%) for progressive cancer. Treatmentrelated grade 3-4 toxicity was 32% (95% CI: 21-45%). Conclusion This meta-analysis shows that downstaging of the lesion following neoadjuvant therapies is uncommon for patients with borderline resectable pancreatic cancer. A clear benefit of this regimen could be to spare surgery to patients with progressive disease during the frame-time chemo-radiotherapy is being delivered.

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KW - Evidence-based medicine

KW - Meta-analysis as topic

KW - Neoadjuvant therapy

KW - Pancreatic carcinoma

KW - Pancreatic neoplasms

KW - Radiotherapy

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