Neoadjuvant Chemo-Radiotherapy for Patients with Borderline Resectable Pancreatic Cancer: A Meta-Analytical Evaluation of Prospective Studies

  • Virginia Festa Division of Gastroenterology, “San Filippo Neri” Hospital. Rome, Italy
  • Angelo Andriulli Division of Gastroenterology, "Casa Sollievo della Sofferenza" Hospital, IRCCS. San Giovanni Rotondo, FG, Italy
  • Maria Rosaria Valvano Division of Gastroenterology, "Casa Sollievo della Sofferenza" Hospital, IRCCS. San Giovanni Rotondo, FG, Italy
  • Generoso Uomo Department of Internal Medicine, Cardarelli Hospital. Naples, Italy
  • Francesco Perri Division of Gastroenterology, "Casa Sollievo della Sofferenza" Hospital, IRCCS. San Giovanni Rotondo, FG, Italy
  • Nicola Andriulli Department of Chemical Pharmaceutics, “La Sapienza” University. Rome, Italy
  • Salvatore Corrao Biomedical Department of Internal Medicine and Subspecialties, University of Palermo. Palermo, Italy
  • Maurizio Koch Division of Gastroenterology, “San Filippo Neri” Hospital. Rome, Italy
Keywords: Drug Therapy, Evidence-Based Medicine, Meta-Analysis as Topic, Neoadjuvant Therapy, Pancreatic Carcinoma, Pancreatic Neoplasms, Radiotherapy

Abstract

Context For patients with borderline resectable pancreatic cancer, the benefit of neoadjuvant therapy remains to be defined. Objective We did a systematic search of the literature on this topic. Methods Prospective studies where chemotherapy with or without radiotherapy was given before surgery to patients with borderline resectable cancer, were analyzed by a meta-analytical approach. Main outcome measures Primary outcome was surgical exploration and resection rates; tumor response, therapy-induced toxicity, and survival were secondary outcomes. Data were expressed as weighted pooled proportions with 95% confidence intervals (95% CI). Results Ten studies with 182 participants were included. Following treatment, 69% of patients (95% CI: 56-80%) were brought to surgery and 80% (95% CI: 66-90%) of surgically-explored patients were resected. Eighty-three percent (95% CI: 74-90%) of resected specimens were deemed R0 resections. The weighted fractions of resected patients alive at 1 and 2 years were 61% (95% CI: 48-100%) and 44% (95% CI: 32-59%), respectively. At restaging following neoadjuvant therapy, weighted frequencies for complete/partial response were 16% (95% CI: 9-28%), 69% (95% CI: 60-76%) for stable disease, and 19% (95% CI: 13-25%) for progressive cancer. Treatment-related grade 3-4 toxicity was 32% (95% CI: 21-45%). Conclusion This meta-analysis shows that downstaging of the lesion following neoadjuvant therapies is uncommon for patients with borderline resectable pancreatic cancer. A clear benefit of this regimen could be to spare surgery to patients with progressive disease during the frame-time chemo-radiotherapy is being delivered.

Image: PRISMA 2009 flow diagram.

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Author Biography

Virginia Festa, Division of Gastroenterology, “San Filippo Neri” Hospital. Rome, Italy
Gastroenterology and Hepatology Department. Medical Manager

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PRISMA 2009 flow diagram
Published
2013-11-10
How to Cite
FestaV., AndriulliA., ValvanoM. R., UomoG., PerriF., AndriulliN., CorraoS., & KochM. (2013). Neoadjuvant Chemo-Radiotherapy for Patients with Borderline Resectable Pancreatic Cancer: A Meta-Analytical Evaluation of Prospective Studies. JOP. Journal of the Pancreas, 14(6), 618-625. https://doi.org/10.6092/1590-8577/1724
Section
ORIGINAL ARTICLES

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