Neoadjuvant radiotherapy after (m)FOLFIRINOX for borderline resectable pancreatic adenocarcinoma: A TAPS Consortium study Journal Article
| Authors: | Janssen, Q. P.; van Dam, J. L.; Prakash, L. R.; Doppenberg, D.; Crane, C. H.; van Eijck, C. H. J.; Ellsworth, S. G.; Jarnagin, W. R.; O'Reilly, E. M.; Paniccia, A.; Reyngold, M.; Besselink, M. G.; Katz, M. H. G.; Tzeng, C. W. D.; Zureikat, A. H.; Groot Koerkamp, B.; Wei, A. C.; for the Trans-Atlantic Pancreatic Surgery (TAPS) Consortium |
| Article Title: | Neoadjuvant radiotherapy after (m)FOLFIRINOX for borderline resectable pancreatic adenocarcinoma: A TAPS Consortium study |
| Abstract: | BACKGROUND: The value of neoadjuvant radiotherapy (RT) after 5-fluorouracil with leucovorin, oxaliplatin, and irinotecan, with or without dose modifications [(m)FOLFIRINOX], for patients with borderline resectable (BR) pancreatic ductal adenocarcinoma (PDAC) is uncertain. METHODS: We conducted an international retrospective cohort study including consecutive patients with BR PDAC who received (m)FOLFIRINOX as initial treatment (2012-2019) from the Trans-Atlantic Pancreatic Surgery Consortium. Because the decision to administer RT is made after chemotherapy, patients with metastases or deterioration after (m)FOLFIRINOX or a performance score ≥2 were excluded. Patients who received RT after (m)FOLFIRINOX were matched 1:1 by nearest neighbor propensity scores with patients who did not receive RT. Propensity scores were calculated using sex, age (≤70 vs >70 years), WHO performance score (0 vs 1), tumor size (0-20 vs 21-40 vs >40 mm), tumor location (head/uncinate vs body/tail), number of cycles (1-4 vs 5-8 vs >8), and baseline CA 19-9 level (≤500 vs >500 U/mL). Primary outcome was overall survival (OS) from diagnosis. RESULTS: Of 531 patients who received neoadjuvant (m)FOLFIRINOX for BR PDAC, 424 met inclusion criteria and 300 (70.8%) were propensity score-matched. After matching, median OS was 26.2 months (95% CI, 24.0-38.4) with RT versus 32.8 months (95% CI, 25.3-42.0) without RT (P=.71). RT was associated with a lower resection rate (55.3% vs 72.7%; P=.002). In patients who underwent a resection, RT was associated with a comparable margin-negative resection rate (>1 mm) (70.6% vs 64.8%; P=.51), more node-negative disease (57.3% vs 37.6%; P=.01), and more major pathologic response with <5% tumor viability (24.7% vs 8.3%; P=.006). The OS associated with conventional and stereotactic body RT approaches was similar (median OS, 25.7 vs 26.0 months; P=.92). CONCLUSIONS: In patients with BR PDAC, neoadjuvant RT following (m)FOLFIRINOX was associated with more node-negative disease and better pathologic response in patients who underwent resection, yet no difference in OS was found. Routine use of RT cannot be recommended based on these data. |
| Keywords: | aged; retrospective studies; fluorouracil; neoadjuvant therapy; pancreatic neoplasms; antineoplastic agent; adenocarcinoma; antineoplastic combined chemotherapy protocols; pathology; retrospective study; irinotecan; folinic acid; pancreas tumor; oxaliplatin; leucovorin; humans; human; folfirinox |
| Journal Title: | Journal of the National Comprehensive Cancer Network |
| Volume: | 20 |
| Issue: | 7 |
| ISSN: | 1540-1405 |
| Publisher: | Harborside Press |
| Date Published: | 2022-07-01 |
| Start Page: | 783 |
| End Page: | 791 |
| Language: | English |
| DOI: | 10.6004/jnccn.2022.7008 |
| PUBMED: | 35830887 |
| PROVIDER: | scopus |
| PMCID: | PMC9326480 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 August 2022 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work