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Preoperative FOLFIRINOX for borderline resectable pancreatic cancer: Is radiation necessary in the modern era of chemotherapy?
Author(s) -
Kim Sunhee S.,
Nakakura Eric K.,
Wang Zhen J.,
Kim Grace E.,
Corvera Carlos U.,
Harris Hobart W.,
Kirkwood Kimberly S.,
Hirose Ryutaro,
Tempero Margaret A.,
Ko Andrew H.
Publication year - 2016
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24375
Subject(s) - folfirinox , medicine , pancreatic cancer , radiation therapy , surgery , chemotherapy , neoadjuvant therapy , radiology , cancer , irinotecan , colorectal cancer , breast cancer
Background No consensus exists regarding the optimal neoadjuvant treatment paradigm for patients with borderline resectable pancreatic cancer (BRPC), including the respective roles of chemotherapy and radiation. Methods We performed a retrospective analysis, including detailed pathologic and radiologic review, of pancreatic cancer patients undergoing FOLFIRINOX, with or without radiation therapy (RT), prior to surgical resection at a high‐volume academic center over a 4‐year period. Results Of 26 patients meeting inclusion criteria, 22 (84.6%) received FOLFIRINOX alone without RT (median number of treatment cycles = 9). The majority of patients met formal radiographic criteria for BRPC, with the superior mesenteric vein representing the most common vessel involved. R0 resection rate was 90.9%, with 12 patients (54.5%) requiring vascular reconstruction. Treatment response was classified as moderate or marked in 16 patients (72.7%) according to the College of American Pathologists grading system. Estimated median disease‐free and overall survival rates are 22.6 months and not reached (NR), respectively. Conclusions This is one of the largest series to describe the use of neoadjuvant FOLFIRINOX, without radiation therapy, in patients with BRPC undergoing surgical resection. Given the high R0 resection rates and favorable clinical outcomes with chemotherapy alone, this strategy should be further assessed in prospective study design. J. Surg. Oncol. 2016;114:587–596 . © 2016 Wiley Periodicals, Inc.