Preoperative FOLFIRINOX for Borderline Resectable Pancreatic Cancer: Is Radiation Necessary in the Modern Era of Chemotherapy?
Preoperative FOLFIRINOX for Borderline Resectable Pancreatic Cancer: Is Radiation Necessary in the Modern Era of Chemotherapy?
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DOI：
10.1002/jso.24375
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发表时间：
2016-10-01
影响因子：
2.5
通讯作者：
Ko, Andrew H.
中科院分区：
文献类型：
--
作者：
Kim, Sunhee S.;Nakakura, Eric K.;Ko, Andrew H.
背景资料：关于临界可切除胰腺癌（BRPC）患者的最佳新辅助治疗模式，包括化疗和放疗各自的作用，目前还没有达成共识。我们对接受FOLFIRINOX治疗的胰腺癌患者进行了回顾性分析，包括详细的病理学和放射学检查，结果：在26例符合入选标准的患者中，22例（84.6%）接受FOLFIRINOX单药治疗，未接受RT（中位治疗周期数= 9）。大多数患者符合BRPC的正式放射学标准，其中上级肠系膜静脉是最常见的受累血管。R0切除率为90.9%，12例患者（54.5%）需要血管重建。根据美国病理学家学会分级系统，16例患者（72.7%）的治疗反应被归类为中度或显著。估计中位无病生存率和总生存率为22.6个月，未达到（NR），respectively.Conclusions：这是一个最大的系列来描述使用新辅助FOLFIRINOX，没有放射治疗，在接受手术切除的BRPC患者。鉴于单纯化疗的高R0切除率和良好的临床结局，该策略应在前瞻性研究设计中进一步评估。(C)2016 Wiley Periodicals，Inc.
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. (C) 2016 Wiley Periodicals, Inc.