A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma
A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma
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DOI：
10.1186/1471-2407-12-199
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发表时间：
2012-05-29
期刊：
影响因子：
3.8
通讯作者：
Rocha-Lima, Caio M.
中科院分区：
文献类型：
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作者：
Hosein, Peter J.;Macintyre, Jessica;Rocha-Lima, Caio M.
背景：在表现状态良好的转移性胰腺癌患者中，5-氟尿嘧啶、亚叶酸钙、伊立替康和奥沙利铂(FOLFIRINOX)优于吉西他滨。我们研究了这种联合疗法作为局部晚期胰腺癌(LAPC)的新辅助治疗方法。方法：在这一回顾系列中，我们纳入了接受新辅助FOLFIRINOX和生长因子支持的不能切除的LAPC患者。主要分析终点是R0切除率。结果：18名未接受治疗的不能切除或边缘可切除的LAPC患者接受了新辅助FOLFIRINOX治疗。中位年龄为57.5岁，ECOG评分均为0或1。11例(61%)胰头肿瘤，9例(50%)化疗前放置胆道支架。共146个周期，平均每个患者8个周期(3-17个周期)。在最大反应或耐受性时，7例(39%)根据放射学标准转为可切除；5例接受R0切除，1例接受R1切除，1例患有不能切除的疾病。在FOLFIRINOX后仍无法切除的11例患者中，3例在联合放化疗后进行了R0切除，总体R0切除率为44%(95%可信区间22-69%)。中位随访13.4个月，1年无进展生存率83%(95%可信区间59~96%)，1年总生存率100%(95%可信区间85~100%)。与化疗相关的3级/4级毒副反应为中性粒细胞减少(22%)、中性粒细胞减少热(17%)、血小板减少(11%)、乏力(11%)和腹泻(11%)。常见的1/2级毒副反应为中性粒细胞减少(33%)、贫血(72%)、血小板减少(44%)、乏力(78%)、恶心(50%)、腹泻(33%)和神经病变(33%)。结论：FOLFIRINOX联合放化疗治疗不能手术切除的LAPC是可行的。这一人群中44%的R0切除率是很有希望的。有必要进行进一步的研究。
Background: 5-fluorouracil, leucovorin, irinotecan and oxaliplatin (FOLFIRINOX) is superior to gemcitabine in patients with metastatic pancreatic cancer who have a good performance status. We investigated this combination as neoadjuvant therapy for locally advanced pancreatic cancer (LAPC).Methods: In this retrospective series, we included patients with unresectable LAPC who received neoadjuvant FOLFIRINOX with growth factor support. The primary analysis endpoint was R0 resection rate.Results: Eighteen treatment-naive patients with unresectable or borderline resectable LAPC were treated with neoadjuvant FOLFIRINOX. The median age was 57.5 years and all had ECOG PS of 0 or 1. Eleven (61 %) had tumors in the head of the pancreas and 9 (50 %) had biliary stents placed prior to chemotherapy. A total of 146 cycles were administered with a median of 8 cycles (range 3-17) per patient. At maximum response or tolerability, 7 (39 %) were converted to resectability by radiological criteria; 5 had R0 resections, 1 had an R1 resection, and 1 had unresectable disease. Among the 11 patients who remained unresectable after FOLFIRINOX, 3 went on to have R0 resections after combined chemoradiotherapy, giving an overall R0 resection rate of 44 % (95 % CI 22-69 %). After a median follow-up of 13.4 months, the 1-year progression-free survival was 83 % (95 % CI 59-96 %) and the 1-year overall survival was 100 % (95 % CI 85-100 %). Grade 3/4 chemotherapy-related toxicities were neutropenia (22 %), neutropenic fever (17 %), thrombocytopenia (11 %), fatigue (11 %), and diarrhea (11 %). Common grade 1/2 toxicities were neutropenia (33 %), anemia (72 %), thrombocytopenia (44 %), fatigue (78 %), nausea (50 %), diarrhea (33 %) and neuropathy (33 %).Conclusions: FOLFIRINOX followed by chemoradiotherapy is feasible as neoadjuvant therapy in patients with unresectable LAPC. The R0 resection rate of 44 % in this population is promising. Further studies are warranted.