Impact and optimal timing of local therapy addition in borderline resectable or locally advanced pancreatic cancer after FOLFIRINOX chemotherapy

被引：2

作者：

Kim, Kangpyo ^{[1
]}

Park, Hee Chul ^{[1
]}

Yu, Jeong Il ^{[1
]}

Park, Joon Oh ^{[2
]}

Hong, Jung Yong ^{[2
]}

Lee, Kyu Taek ^{[3
]}

Lee, Kwang Hyuck ^{[3
]}

Lee, Jong Kyun ^{[3
]}

Park, Joo Kyung ^{[3
]}

Heo, Jin Seok ^{[4
]}

Shin, Sang Hyun ^{[4
]}

Min, Ji Hye ^{[5
]}

Kim, Kyunga ^{[6
,7
,8
]}

Han, In Woong ^{[4
]}

机构：

[1] Sungkyunkwan Univ, Samsung Med Ctr, Dept Radiat Oncol, Sch Med, 81 Irwon Ro, Seoul 06351, South Korea

[2] Sungkyunkwan Univ, Samsung Med Ctr, Dept Med, Div Hematol Oncol,Sch Med, Seoul, South Korea

[3] Sungkyunkwan Univ, Samsung Med Ctr, Dept Med, Div Gastroenterol,Sch Med, Seoul, South Korea

[4] Sungkyunkwan Univ, Samsung Med Ctr, Dept Surg, Sch Med, 81 Irwon Ro, Seoul 06351, South Korea

[5] Sungkyunkwan Univ, Samsung Med Ctr, Dept Radiol, Sch Med, Seoul, South Korea

[6] Res Inst Future Med, Biomed Stat Ctr, Samsung Med Ctr, Seoul, South Korea

[7] Sungkyunkwan Univ, Samsung Adv Inst Hlth Sci & Technol, Dept Digital Hlth, Seoul, South Korea

[8] Sungkyunkwan Univ, Dept Data Convergence & Future Med, Sch Med, Seoul, South Korea

来源：

CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY | 2024年 / 45卷

基金：

新加坡国家研究基金会;

关键词：

Pancreatic ductal adenocarcinoma; Multimodal treatments; Timing of local treatments; Neoadjuvant treatment; FOLFIRINOX; RADIATION-THERAPY; GEMCITABINE; RADIOTHERAPY; ADENOCARCINOMA; SURVIVAL; OUTCOMES; TRIAL;

D O I：

10.1016/j.ctro.2024.100732

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: To evaluate the efficacy and optimal timing of local treatment in patients with borderline resectable (BR) or locally advanced pancreatic cancer (LAPC) treated with upfront FOLFIRINOX. Method: Between 2015 and 2020, 258 patients with pancreatic ductal adenocarcinoma (PDAC) were analysed. Treatment outcomes were compared between systemic treatment group (ST) and multimodality treatment groups (MT) using Kaplan-Meier curves and log-rank test. The MT were stratified as follows: FOLFIRINOX + radiation therapy (RT) (MT1), FOLFIRINOX + surgical resection (MT2), and FOLFIRINOX + RT + surgical resection (MT3). Results: With median follow-up period of 18 months, the 2-year overall survival (OS) for the ST was 22.0%, and it was significantly worse than MT (MT1, 46.3%; MT2, 65.7% and MT3; 90.2%; P < .001). The 2-year locoregional progression free survival (LRPFS) and overall PFS in ST were 10.7% and 7.0%, which were also significantly lower than those of MT (2-year LRPFS: MT1, 31.8%; MT2, 45.3%; MT3, 81.0%; 2-year overall PFS: MT1, 23.3%; MT2, 35.0%; MT3, 66.3%; P < .001). In time-varying multivariate Cox proportional hazard model, local treatment contributed to better treatment outcomes, with adjusted hazard ratios of 0.568 (95% confidence interval [CI], 0.398-0.811), 0.490 (95% CI, 0.331-0.726), and 0.656 (95% CI, 0.458-0.940) for OS, LRPFS, and overall PFS, respectively. The time window of 11-17 months after FOLFIRINOX appeared to demonstrate the maximal efficacy of local treatments in OS. Conclusions: Adding local treatment in BR/LAPC patients treated with upfront FOLFIRINOX seemed to contribute in improved treatment outcomes, and it showed maximal efficacy in OS when applied 11-17 months after the initiation of FOLFIRINOX. We suggest that administration of sufficient period of upfront FOLFIRINOX may intensify the efficacy of local treatments, and well controlled prospective trials are expected.

引用

页数：8

共 37 条

[1] Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: A randomized trial [J].

Burris, HA ;

Moore, MJ ;

Andersen, J ;

Green, MR ;

Rothenberg, ML ;

Madiano, MR ;

Cripps, MC ;

Portenoy, RK ;

Storniolo, AM ;

Tarassoff, P ;

Nelson, R ;

Dorr, FA ;

Stephens, CD ;

VanHoff, DD .

JOURNAL OF CLINICAL ONCOLOGY, 1997, 15 (06) :2403-2413

[2] A prospective observational study of the clinical and pathological impact of stereotactic body radiotherapy (SBRT) as a neoadjuvant strategy of chemoradiation in pancreatic cancer [J].

Chen-Zhao, X. ;

Hernando, O. ;

Lopez, M. ;

Sanchez, E. ;

Montero, A. ;

Garcia-Aranda, M. ;

Ciervide, R. ;

Valero, J. ;

Alonso, R. ;

Cardenas-Rebollo, J. M. ;

Vicente, E. ;

Quijano, Y. ;

Cubillo, A. ;

Alvarez, R. ;

Prados, S. ;

Plaza, C. ;

Garcia, J. ;

Zucca, D. ;

Fernandez-Leton, P. ;

Rubio, C. .

CLINICAL & TRANSLATIONAL ONCOLOGY, 2020, 22 (09) :1499-1505

[3] Adjuvant treatment for resectable pancreatic cancer [J].

Chua, YJ ;

Cunningham, D .

JOURNAL OF CLINICAL ONCOLOGY, 2005, 23 (20) :4532-4537

[4] Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer A Randomized Clinical Trial [J].

Conroy, Thierry ;

Castan, Florence ;

Lopez, Anthony ;

Turpin, Anthony ;

Ben Abdelghani, Meher ;

Wei, Alice C. ;

Mitry, Emmanuel ;

Biagi, James J. ;

Evesque, Ludovic ;

Artru, Pascal ;

Lecomte, Thierry ;

Assenat, Eric ;

Bauguion, Lucile ;

Ychou, Marc ;

Bouche, Olivier ;

Monard, Laure ;

Lambert, Aurelien ;

Hammel, Pascal .

JAMA ONCOLOGY, 2022, 8 (11) :1571-1578

[5] FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic Cancer [J].

Conroy, Thierry ;

Desseigne, Francoise ;

Ychou, Marc ;

Bouche, Olivier ;

Guimbaud, Rosine ;

Becouarn, Yves ;

Adenis, Antoine ;

Raoul, Jean-Luc ;

Gourgou-Bourgade, Sophie ;

de la Fouchardiere, Christelle ;

Bennouna, Jaafar ;

Bachet, Jean-Baptiste ;

Khemissa-Akouz, Faiza ;

Pere-Verge, Denis ;

Delbaldo, Catherine ;

Assenat, Eric ;

Chauffert, Bruno ;

Michel, Pierre ;

Montoto-Grillot, Christine ;

Ducreux, Michel .

NEW ENGLAND JOURNAL OF MEDICINE, 2011, 364 (19) :1817-1825

[6] Annual report to the nation on the status of cancer, part 1: National cancer statistics [J].

Cronin, Kathleen A. ;

Scott, Susan ;

Firth, Albert U. ;

Sung, Hyuna ;

Henley, S. Jane ;

Sherman, Recinda L. ;

Siegel, Rebecca L. ;

Anderson, Robert N. ;

Kohler, Betsy A. ;

Benard, Vicki B. ;

Negoita, Serban ;

Wiggins, Charles ;

Cance, William G. ;

Jemal, Ahmedin .

CANCER, 2022, 128 (24) :4251-4284

[7] Stereotactic body radiotherapy for unresected pancreatic cancer: A nationwide review [J].

de Geus, Susanna W. L. ;

Eskander, Mariam F. ;

Kasumova, Gyulnara G. ;

Ng, Sing Chau ;

Kent, Tara S. ;

Mancias, Joseph D. ;

Callery, Mark P. ;

Mahadevan, Anand ;

Tseng, Jennifer F. .

CANCER, 2017, 123 (21) :4158-4167

[8] Could Total Neoadjuvant Therapy Followed by Surgical Resection Be the New Standard of Care in Pancreatic Cancer? A Systematic Review and Meta-Analysis [J].

De Simoni, Ottavia ;

Scarpa, Marco ;

Solda, Caterina ;

Bergamo, Francesca ;

Lonardi, Sara ;

Fantin, Alberto ;

Pilati, Pierluigi ;

Gruppo, Mario .

JOURNAL OF CLINICAL MEDICINE, 2022, 11 (03)

[9] New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1) [J].

Eisenhauer, E. A. ;

Therasse, P. ;

Bogaerts, J. ;

Schwartz, L. H. ;

Sargent, D. ;

Ford, R. ;

Dancey, J. ;

Arbuck, S. ;

Gwyther, S. ;

Mooney, M. ;

Rubinstein, L. ;

Shankar, L. ;

Dodd, L. ;

Kaplan, R. ;

Lacombe, D. ;

Verweij, J. .

EUROPEAN JOURNAL OF CANCER, 2009, 45 (02) :228-247

[10] Radiological and Surgical Implications of Neoadjuvant Treatment With FOLFIRINOX for Locally Advanced and Borderline Resectable Pancreatic Cancer [J].

Ferrone, Cristina R. ;

Marchegiani, Giovanni ;

Hong, Theodore S. ;

Ryan, David P. ;

Deshpande, Vikram ;

McDonnell, Erin I. ;

Sabbatino, Francesco ;

Santos, Daniela Dias ;

Allen, Jill N. ;

Blaszkowsky, Lawrence S. ;

Clark, Jeffrey W. ;

Faris, Jason E. ;

Goyal, Lipika ;

Kwak, Eunice L. ;

Murphy, Janet E. ;

Ting, David T. ;

Wo, Jennifer Y. ;

Zhu, Andrew X. ;

Warshaw, Andrew L. ;

Lillemoe, Keith D. ;

Fernandez-del Castillo, Carlos .

ANNALS OF SURGERY, 2015, 261 (01) :12-17

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