TITLE:
A Systematic Review of Neoadjuvant Therapy Compared to the “Resection First” Approach for Patients with Borderline Resectable Pancreatic Adenocarcinoma
AUTHORS:
Paul G. Toomey, Sharona Ross, Shalin Shah, Alexander S. Rosemurgy
KEYWORDS:
Adenocarcinoma; Borderline; Cancer; Chemotherapy; Chemoradiation; Neoadjuvant; Pancreatic; Resectable
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.5 No.1,
January
17,
2014
ABSTRACT:
Background: Survival
for patients with pancreatic adenocarcinoma continues to be poor. Patients with
pancreatic adenocarcinoma that is deemed borderline resectable have imaging
that shows disease involvement of the portal vein and/or superior mesenteric
vein that is amenable to reconstruction or abutment (≤180 degrees) of the
superior mesenteric artery. The best initial treatment for patients with
borderline resectable pancreatic adenocarcinoma has yet to be determined.
Proponents of neoadjuvant therapy purport its utility for patients with
borderline resectable pancreatic adenocarcinoma with the intention of
increasing the likelihood of a microscopically negative (R0) margin, but the consequences of this approach
are not established. This study was undertaken to systematically review the
outcomes for patients with borderline resectable pancreatic adenocarcinoma to
compare neoadjuvant therapy to a “resection first” approach. Methods: A MEDLINE/PubMed search was undertaken
to find all studies regarding patients who underwent neoadjuvant therapy for
patients with borderline resectable pancreatic adenocarcinoma. Results: A total
of 112 studies were found regarding borderline resectable pancreatic cancer.
Fourteen studies contained cohorts of patients with borderline resectable
pancreatic adenocarcinoma who received neoadjuvant therapy (n = 471 patients) or a resection-first
approach (n = 76 patients). Resection after
neoadjuvant therapy was undertaken for 233 (49%) patients. Neoadjuvant therapy
followed by an R0 resection occurred for 42% of patients. For patients who
underwent resection first, 71% (54/76) had an R0 margin. Conclusion:
Patients with borderline resectable pancreatic adenocarcinoma were more often
found to undergo neoadjuvant therapy than a “resection first” approach in the
available literature. Although neoadjuvant therapy portends a high rate of R0
resections, less than half of the patients who undergo neoadjuvant therapy for
borderline resectable pancreatic adenocarcinoma undergo resection. Patients who
undergo “resection first” for borderline resectable pancreatic adenocarcinoma
have an increased chance for a resection and an R0 margin compared to patients who undergo neoadjuvant
therapy for borderline pancreatic adenocarcinoma.