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. 2017 Aug;8(4):683-695.
doi: 10.21037/jgo.2017.04.01.

The role of induction chemotherapy + chemoradiotherapy in localised pancreatic cancer: initial experience in Scotland

Derek Grose  1 , David McIntosh  1 , Nigel Jamieson  1 , Ross Carter  1 , Euan Dickson  1 , David Chang  1 , Husam Marashi  1 , Christina Wilson  1 , Mohammed Alfayez  1 , Ashleigh Kerr  1 , Roisin O'Donoghue  1 , Lea Haskins  1 , Fraser Duthie  1 , Colin J McKay  1 , Janet Graham  1
Affiliations

The role of induction chemotherapy + chemoradiotherapy in localised pancreatic cancer: initial experience in Scotland

Derek Grose et al. J Gastrointest Oncol. 2017 Aug.

Abstract

Background: Despite being relatively rare pancreatic cancer is one of the highest causes of death. Even within the potentially resectable group outcomes are poor. We present our initial experiences utilising a neoadjuvant approach to localised pancreatic cancer, evaluating survival, response rates and tolerability.

Methods: This was a retrospective analysis of a prospectively maintained database. Patients from 2012 to 2015 referred to a busy regional Hepato-Pancreatic Biliary (HPB) MDT were included. Patients were classified according to respectability criteria (utilising NCCN guidelines) and a treatment plan agreed. Systemic therapy with either FOLFIRINOX or Gem/Cap was delivered followed by chemoradiotherapy if disease remained localised. Toxicity, response, pathological outcomes and survival were all recorded.

Results: A total of 85 patients were included in the study: 45 had initially resectable disease; 19 required a response for resection and 21 had locally advanced inoperable disease; 34 patients underwent resection. The median survival for the potentially resectable group was 22.2 months while for those undergoing resection it was 37 months.

Conclusions: We have demonstrated that a neoadjuvant approach is deliverable and tolerable. In addition we have demonstrated impressive survival results in patients undergoing resection with no detriment in outcome for those not proceeding to surgery.

Keywords: Pancreatic cancer; chemoradiotherapy; chemotherapy; neoadjuvant.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Definitions of resectability: Glasgow resection criteria.
Figure 2
Figure 2
Consort diagram all patients. Multimodality treatment: lines of treatment all non-Metastatic patients.
Figure 3
Figure 3
Consort diagram surgical patients. Multimodality treatment: lines of treatment for patients when surgery was planned from the outset.
Figure 4
Figure 4
The relationship between stage (B vs. C vs. D from top to bottom) and survival in all patients (log rank P<0.001).
Figure 5
Figure 5
The relationship between stage (B vs. C from top to bottom) and survival in all patients who underwent radical resection (log rank P<0.001).
See this image and copyright information in PMC

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