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Neoadjuvant Stereotactic Body Radiotherapy After Upfront Chemotherapy Improves Pathologic Outcomes Compared With Chemotherapy Alone for Patients With Borderline Resectable or Locally Advanced Pancreatic Adenocarcinoma Without Increasing Perioperative Toxicity.
Hill, Colin S; Rosati, Lauren M; Hu, Chen; Fu, Wei; Sehgal, Shuchi; Hacker-Prietz, Amy; Wolfgang, Christopher L; Weiss, Matthew J; Burkhart, Richard A; Hruban, Ralph H; De Jesus-Acosta, Ana; Le, Dung T; Zheng, Lei; Laheru, Daniel A; He, Jin; Narang, Amol K; Herman, Joseph M.
Afiliação
  • Hill CS; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA.
  • Rosati LM; University of South Carolina School of Medicine, Columbia, SC, USA.
  • Hu C; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA.
  • Fu W; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA.
  • Sehgal S; Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA.
  • Hacker-Prietz A; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA.
  • Wolfgang CL; Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA.
  • Weiss MJ; Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA.
  • Burkhart RA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  • Hruban RH; Department of Pathology, the Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  • De Jesus-Acosta A; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  • Le DT; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  • Zheng L; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  • Laheru DA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  • He J; Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA.
  • Narang AK; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA. Anarang2@jhmi.edu.
  • Herman JM; Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA. Jherman1@northwell.edu.
Ann Surg Oncol ; 29(4): 2456-2468, 2022 Apr.
Article em En | MEDLINE | ID: mdl-35129721
BACKGROUND: Patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) are at high risk of margin-positive resection. Neoadjuvant stereotactic body radiation therapy (SBRT) may help sterilize margins, but its additive benefit beyond neoadjuvant chemotherapy (nCT) is unclear. The authors report long-term outcomes for BRPC/LAPC patients explored after treatment with either nCT alone or nCT followed by five-fraction SBRT (nCT-SBRT). METHODS: Patients with BRPC or LAPC from 2011 to 2016 who underwent resection after nCT alone or nCT-SBRT were retrospectively reviewed. Baseline characteristics were compared, and the propensity score with inverse probability weighting (IPW) was used to compare pathologic/survival outcomes. RESULTS: Of 198 patients, 76 received nCT, and 122 received nCT-SBRT. The nCT-SBRT cohort had a higher proportion of LAPC (53% vs 22%; p < 0.001). The duration of nCT was longer for nCT-SBRT (4.6 vs 2.9 months; p = 0.03), but adjuvant chemotherapy was less frequently administered (53% vs 67.1%; p < 0.001). Adjuvant radiation was administered to 30% of the nCT patients. The nCT-SBRT regimen more frequently achieved negative margins (92% vs 70%; p < 0.001), negative nodes (59% vs 42%; p < 0.001), and pathologic complete response (7% vs 0%; p = 0.02). In the multivariate analysis, nCT-SBRT remained associated with R0 resection (p < 0.001). The nCT-SBRT cohort experienced no significant difference in median overall survival (OS) (22.1 vs 24.5 months), local progression-free survival (LPFS) (13.5 vs. 15.4 months), or distant metastasis-free survival (DMFS) (11.7 vs 16.3 months) after surgery. After SBRT, 1-year OS was 77.0% and 2-year OS was 50.4%. Perioperative Claven-Dindo grade 3 or greater morbidity did not differ significantly between the nCT and nCT-SBRT cohorts (p = 0.81). CONCLUSIONS: Despite having more advanced disease, the nCT-SBRT cohort was still more likely to undergo an R0 resection and experienced similar survival outcomes compared with the nCT alone cohort.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Pancreáticas / Adenocarcinoma / Radiocirurgia Tipo de estudo: Observational_studies Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Pancreáticas / Adenocarcinoma / Radiocirurgia Tipo de estudo: Observational_studies Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article