The role of neoadjuvant chemoradiation therapy in patients with borderline resectable pancreatic cancer with isolated venous vascular involvement

Jin Ho Lee, ChangMoo Kang, Seung Min Bang, Jin Young Choi, Jinsil Seong, Ho Kyoung Hwang, Sung Hoon Choi, Woo Jung Lee, Wenfu Tang

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11 Citations (Scopus)

Abstract

The rationale for neoadjuvant chemoradiation therapy (Neo-CRT) and the definition of borderline resectable pancreatic cancer (BRPC) are still controversial. In particular, surgical treatment of BRPC with isolated venous vascular involvement (IVVI) is debatable. From January 2000 to December 2013, 84 patients diagnosed with BRPC according to NCCN guidelines were identified, and 70 patients were found to have BRPC with IVVI. We divided all 70 patients into 3 groups: surgery first without Neo-CRT (Group 1); pancreatectomy following Neo-CRT (Group 2); and no operation following Neo-CRT (Group 3). Patient characteristics including oncologic outcomes were analyzed for each of the 3 patients groups. Thirty-seven patients were female and 33 were male, with a mean age of 61.7 ± 9.74 years. Among the 70 BRPC patients with IVVI, 28 patients (40%) belonged to Group 1, 30 patients (42.9%) belonged to Group 2, and 12 patients (17.1%) belonged to Group 3. Pathological tumor size (P < 0.001), pT stage (P = 0.001), pTNM stage (P = 0.002), combined vascular resection (P = 0.003), completeness of adjuvant therapy (P = 0.004) were found to be statistically significantly different between Groups 1 and 2. In addition, disease-free survival (P = 0.055) and disease-specific survival (DSS) (P = 0.006) were improved in Group 2. Interestingly, when comparing DSS, there was no statistically significant difference between Groups 1 and 3 (P = 0.991). The clinical practice of pancreatectomy following Neo-CRT in BRPC with IVVI provided favorable oncologic outcomes. The effect of Neo-CRT in BRPC with IVVI may be multifactorial, providing proper patient selection, complete adjuvant chemotherapy, and potential therapeutic (downstaging) effect.

Original languageEnglish
Article numbere1233
JournalMedicine (United States)
Volume94
Issue number31
DOIs
Publication statusPublished - 2015 Aug 1

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Neoadjuvant Therapy
Pancreatic Neoplasms
Blood Vessels
Pancreatectomy
Survival
Therapeutic Uses
Adjuvant Chemotherapy
Patient Selection
Disease-Free Survival
Guidelines

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Lee, Jin Ho ; Kang, ChangMoo ; Bang, Seung Min ; Choi, Jin Young ; Seong, Jinsil ; Hwang, Ho Kyoung ; Choi, Sung Hoon ; Lee, Woo Jung ; Tang, Wenfu. / The role of neoadjuvant chemoradiation therapy in patients with borderline resectable pancreatic cancer with isolated venous vascular involvement. In: Medicine (United States). 2015 ; Vol. 94, No. 31.
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abstract = "The rationale for neoadjuvant chemoradiation therapy (Neo-CRT) and the definition of borderline resectable pancreatic cancer (BRPC) are still controversial. In particular, surgical treatment of BRPC with isolated venous vascular involvement (IVVI) is debatable. From January 2000 to December 2013, 84 patients diagnosed with BRPC according to NCCN guidelines were identified, and 70 patients were found to have BRPC with IVVI. We divided all 70 patients into 3 groups: surgery first without Neo-CRT (Group 1); pancreatectomy following Neo-CRT (Group 2); and no operation following Neo-CRT (Group 3). Patient characteristics including oncologic outcomes were analyzed for each of the 3 patients groups. Thirty-seven patients were female and 33 were male, with a mean age of 61.7 ± 9.74 years. Among the 70 BRPC patients with IVVI, 28 patients (40{\%}) belonged to Group 1, 30 patients (42.9{\%}) belonged to Group 2, and 12 patients (17.1{\%}) belonged to Group 3. Pathological tumor size (P < 0.001), pT stage (P = 0.001), pTNM stage (P = 0.002), combined vascular resection (P = 0.003), completeness of adjuvant therapy (P = 0.004) were found to be statistically significantly different between Groups 1 and 2. In addition, disease-free survival (P = 0.055) and disease-specific survival (DSS) (P = 0.006) were improved in Group 2. Interestingly, when comparing DSS, there was no statistically significant difference between Groups 1 and 3 (P = 0.991). The clinical practice of pancreatectomy following Neo-CRT in BRPC with IVVI provided favorable oncologic outcomes. The effect of Neo-CRT in BRPC with IVVI may be multifactorial, providing proper patient selection, complete adjuvant chemotherapy, and potential therapeutic (downstaging) effect.",
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The role of neoadjuvant chemoradiation therapy in patients with borderline resectable pancreatic cancer with isolated venous vascular involvement. / Lee, Jin Ho; Kang, ChangMoo; Bang, Seung Min; Choi, Jin Young; Seong, Jinsil; Hwang, Ho Kyoung; Choi, Sung Hoon; Lee, Woo Jung; Tang, Wenfu.

In: Medicine (United States), Vol. 94, No. 31, e1233, 01.08.2015.

Research output: Contribution to journalArticle

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AU - Lee, Jin Ho

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AB - The rationale for neoadjuvant chemoradiation therapy (Neo-CRT) and the definition of borderline resectable pancreatic cancer (BRPC) are still controversial. In particular, surgical treatment of BRPC with isolated venous vascular involvement (IVVI) is debatable. From January 2000 to December 2013, 84 patients diagnosed with BRPC according to NCCN guidelines were identified, and 70 patients were found to have BRPC with IVVI. We divided all 70 patients into 3 groups: surgery first without Neo-CRT (Group 1); pancreatectomy following Neo-CRT (Group 2); and no operation following Neo-CRT (Group 3). Patient characteristics including oncologic outcomes were analyzed for each of the 3 patients groups. Thirty-seven patients were female and 33 were male, with a mean age of 61.7 ± 9.74 years. Among the 70 BRPC patients with IVVI, 28 patients (40%) belonged to Group 1, 30 patients (42.9%) belonged to Group 2, and 12 patients (17.1%) belonged to Group 3. Pathological tumor size (P < 0.001), pT stage (P = 0.001), pTNM stage (P = 0.002), combined vascular resection (P = 0.003), completeness of adjuvant therapy (P = 0.004) were found to be statistically significantly different between Groups 1 and 2. In addition, disease-free survival (P = 0.055) and disease-specific survival (DSS) (P = 0.006) were improved in Group 2. Interestingly, when comparing DSS, there was no statistically significant difference between Groups 1 and 3 (P = 0.991). The clinical practice of pancreatectomy following Neo-CRT in BRPC with IVVI provided favorable oncologic outcomes. The effect of Neo-CRT in BRPC with IVVI may be multifactorial, providing proper patient selection, complete adjuvant chemotherapy, and potential therapeutic (downstaging) effect.

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