Background <p>Ablative-dose radiotherapy (A-RT) may result in durable local control and encouraging survival for patients with locally advanced pancreatic cancer (LAPC). A subset of patients with LAPC are eligible for exploration after completion of induction chemotherapy and A-RT. Outcomes for this subset of patients are yet to be described.</p> Methods <p>This was a single-institution retrospective analysis of patients who had LAPC treated with induction chemotherapy and A-RT (≥98 Gy biologically effective dose using 15 to 25 fractions in 3- to 4.5-Gy/fraction), then subsequently underwent surgical exploration.</p> Results <p>During a 6-year period, 34 patients with LAPC underwent exploration after induction chemotherapy and A-RT. Chemotherapy was given before A-RT to all the patients, with the majority receiving FOLFIRINOX (94 %). The median time to exploration after completion of A-RT was 75 days. Pancreaticoduodenectomy was the most frequent procedure (<i>n</i> = 18), followed by distal pancreatectomy (<i>n</i> = 7), and resection was aborted in nine patients (26 %) after discovery of distant (<i>n</i> = 6) or locally unresectable (<i>n</i> = 3) disease. Vascular resection or divestment was required for 56 % of the patients. There were no postoperative pancreatic fistulae. However, clinically significant ascites were observed in 36 % of the resected patients. A major pathologic response was observed in 17 % of the resected specimens upon final pathologic review. Postoperative mortality within 90 days occurred for two patients (5.9 %). The median overall survival for the entire cohort was 31 months from the date of diagnosis and 24 months from completion of A-RT.</p> Conclusions <p>Resection of LAPC is feasible for a select cohort of patients after A-RT, with encouraging 2-year overall survival.</p>

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Outcomes in Locally Advanced Pancreatic Cancer After Induction Ablative Radiation Therapy and Resection

  • Alex B. Blair,
  • Joshua S. Jolissaint,
  • Deshka Foster,
  • Kevin C. Soares,
  • Vinod P. Balachandran,
  • T. Peter Kingham,
  • Jeffrey A. Drebin,
  • Michael I. D’Angelica,
  • William R. Jarnagin,
  • Christopher H. Crane,
  • Marsha Reyngold,
  • Alice C. Wei

摘要

Background

Ablative-dose radiotherapy (A-RT) may result in durable local control and encouraging survival for patients with locally advanced pancreatic cancer (LAPC). A subset of patients with LAPC are eligible for exploration after completion of induction chemotherapy and A-RT. Outcomes for this subset of patients are yet to be described.

Methods

This was a single-institution retrospective analysis of patients who had LAPC treated with induction chemotherapy and A-RT (≥98 Gy biologically effective dose using 15 to 25 fractions in 3- to 4.5-Gy/fraction), then subsequently underwent surgical exploration.

Results

During a 6-year period, 34 patients with LAPC underwent exploration after induction chemotherapy and A-RT. Chemotherapy was given before A-RT to all the patients, with the majority receiving FOLFIRINOX (94 %). The median time to exploration after completion of A-RT was 75 days. Pancreaticoduodenectomy was the most frequent procedure (n = 18), followed by distal pancreatectomy (n = 7), and resection was aborted in nine patients (26 %) after discovery of distant (n = 6) or locally unresectable (n = 3) disease. Vascular resection or divestment was required for 56 % of the patients. There were no postoperative pancreatic fistulae. However, clinically significant ascites were observed in 36 % of the resected patients. A major pathologic response was observed in 17 % of the resected specimens upon final pathologic review. Postoperative mortality within 90 days occurred for two patients (5.9 %). The median overall survival for the entire cohort was 31 months from the date of diagnosis and 24 months from completion of A-RT.

Conclusions

Resection of LAPC is feasible for a select cohort of patients after A-RT, with encouraging 2-year overall survival.