Does neoadjuvant treatment in resectable pancreatic cancer improve overall survival? A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Neoadjuvant chemotherapy may improve overall survival (OS) in 'borderline' resectable pancreatic cancer (RPC). Whether the results are the same in upfront RPC is unknown. MATERIALS AND METHODS: To evaluate the association of neoadjuvant treatment and survival outcomes in RPC, a systematic literature review was carried out including prospective randomized trials of neoadjuvant treatment versus upfront surgery. Articles indexed in PubMed, Embase and Scopus were evaluated. Data regarding systemic treatment regimens, R0 resection rates, disease-free survival (DFS) and OS were extracted. The outcomes were compared using a random-effects model. The index I2 and the graphs of funnel plot were used for the interpretation of the data. RESULTS: Of 3229 abstracts, 6 randomized controlled trials were considered eligible with a combined sample size of 805 RPC patients. Among the trials, PACT-15, PREP-02/JSAP-05 and updated long-term results from PREOPANC and NEONAX trials were included. Combining the studies with meta-analysis, we could see that neoadjuvant treatment in RPC does not improve DFS [hazard ratio (HR) 0.71 (0.46-1.09)] or OS [HR 0.76 (0.52-1.11)], without significant heterogeneity. Interestingly, R0 rates improved ∼20% with the neoadjuvant approach [HR 1.2 (1.04-1.37)]. It is important to note that most studies evaluated gemcitabine-based regimens in the neoadjuvant setting. CONCLUSIONS: Neoadjuvant chemotherapy or chemoradiation does not improve DFS or OS in RPC compared to upfront surgery followed by adjuvant treatment. Neoadjuvant treatment improves R0 rates by ∼20%. Randomized ongoing trials are eagerly awaited with more active combined regimens including modified FOLFIRINOX.

Degradation of commercial glyphosate-based herbicide via advanced oxidative processes in aqueous media and phytotoxicity evaluation using maize seeds.

Glyphosate is a herbicide that acts as a broad-spectrum, non-selective, post-emergence systemic pest controller. Its continuing, increasing, and excessive use in many countries in recent years poses a significant threat to the environment and human health due to the prevalence of this herbicide in water bodies and its impact on non-target organisms. In this context, it is essential to develop processes aimed at the non-selective degradation of glyphosate and its by-products. In this study, various advanced oxidative processes were applied: Fenton, electro-Fenton, photoelectro-oxidation, and photoelectro-Fenton, with the objective of oxidizing glyphosate in the commercial product Roundup®. The resultant oxidation products and the phytotoxicological effect on maize seed germination were also analyzed. Following each treatment, chemical oxygen demand (COD), total organic carbon (TOC), glyphosate degradation, and oxidation by-product formation were analyzed. The treated solutions were used to germinate maize seeds for 7 days in a germination chamber applying a photoperiod of 12 h at 24 °C. The % of germination, protein and hydrogen peroxide (H2O2) content, lipid peroxidation extent (MDA), and superoxide dismutase (SOD), peroxidase (POD), and catalase (CAT) activities were determined. The photoelectro-Fenton treatment was the most effective in degrading glyphosate, operating synergistically to break glyphosate bonds, thereby generating non-toxic short-chain molecules. Maize seed germination was satisfactory (> 50 %), but the persistent formation of reactive oxygen species (ROS) led to increased antioxidant activities of SOD, CAT, and POD enzymes acting in a compensatory manner against ROS, thus sustaining the photosynthetic apparatus. Hormesis, a stimulatory effect of glyphosate, was also observed in the presence of low concentrations of glyphosate.