Added Value of Radiotherapy Following Neoadjuvant FOLFIRINOX for Resectable and Borderline Resectable Pancreatic Cancer: A Systematic Review and Meta-Analysis.
Added Value of Radiotherapy Following Neoadjuvant FOLFIRINOX for Resectable and Borderline Resectable Pancreatic Cancer: A Systematic Review and Meta-Analysis.
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DOI：
10.1245/s10434-021-10276-8
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发表时间：
2021-12
影响因子：
3.7
通讯作者：
Groot Koerkamp B
中科院分区：
文献类型：
--
作者：
Janssen QP;van Dam JL;Kivits IG;Besselink MG;van Eijck CHJ;Homs MYV;Nuyttens JJME;Qi H;van Santvoort HJ;Wei AC;de Wilde RF;Wilmink JW;van Tienhoven G;Groot Koerkamp B
在可切除或交界性可切除胰腺癌（（B）RPC）患者中，新辅助FOLFIRINOX化疗后放疗的附加价值尚不清楚。本荟萃分析的目的是比较接受新辅助FOLFIRINOX单药治疗或联合放疗的患者的结局。在Embase、Medline（ovidSP）、Web of Science、Scopus、科克伦和Google Scholar中进行了系统性文献检索。主要终点是合并的中位总生存期（OS）。次要终点包括切除率、R 0切除率和其他病理结局。我们纳入了来自15项研究的512例（B）RPC患者，其中7项为前瞻性非随机研究。总共有351例患者（68.6%）接受FOLFIRINOX单药治疗（8项研究），161例患者（31.4%）接受FOLFIRINOX联合放疗治疗（7项研究）。FOLFIRINOX单药治疗组的汇总估计中位OS为21.6个月（范围18.4-34.0个月），FOLFIRINOX联合放疗组为22.4个月（范围11.0-37.7个月）。汇总切除率相似（71.9% vs. 63.1%，p = 0.43），FOLFIRINOX联合放疗的汇总R 0切除率更高（88.0% vs. 97.6%，p = 0.045）。其他病理结果（ypN 0、病理完全缓解、神经周围浸润）相当。在这项荟萃分析中，与新辅助FOLFIRINOX单独治疗相比，新辅助FOLFIRINOX后放疗与R 0切除率改善相关，但无法证明生存率差异。需要进行随机试验，以确定（B）PRC患者接受新辅助FOLFIRINOX后放疗的附加价值。在线版本包含补充材料，可通过10.1245/s10434-021-10276-8获得。
The added value of radiotherapy following neoadjuvant FOLFIRINOX chemotherapy in patients with resectable or borderline resectable pancreatic cancer ((B)RPC) is unclear. The objective of this meta-analysis was to compare outcomes of patients who received neoadjuvant FOLFIRINOX alone or combined with radiotherapy. A systematic literature search was performed in Embase, Medline (ovidSP), Web of Science, Scopus, Cochrane, and Google Scholar. The primary endpoint was pooled median overall survival (OS). Secondary endpoints included resection rate, R0 resection rate, and other pathologic outcomes. We included 512 patients with (B)RPC from 15 studies, of which 7 were prospective nonrandomized studies. In total, 351 patients (68.6%) were treated with FOLFIRINOX alone (8 studies) and 161 patients (31.4%) were treated with FOLFIRINOX and radiotherapy (7 studies). The pooled estimated median OS was 21.6 months (range 18.4–34.0 months) for FOLFIRINOX alone and 22.4 months (range 11.0–37.7 months) for FOLFIRINOX with radiotherapy. The pooled resection rate was similar (71.9% vs. 63.1%, p = 0.43) and the pooled R0 resection rate was higher for FOLFIRINOX with radiotherapy (88.0% vs. 97.6%, p = 0.045). Other pathological outcomes (ypN0, pathologic complete response, perineural invasion) were comparable. In this meta-analysis, radiotherapy following neoadjuvant FOLFIRINOX was associated with an improved R0 resection rate as compared with neoadjuvant FOLFIRINOX alone, but a difference in survival could not be demonstrated. Randomized trials are needed to determine the added value of radiotherapy following neoadjuvant FOLFIRINOX in patients with (B)PRC. The online version contains supplementary material available at 10.1245/s10434-021-10276-8.
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