Clinical efficacy of modified FOLFIRINOX as neoadjuvant chemotherapy for borderline resectable pancreatic cancer

Abstract

Objective To investigate the clinical efficacy of modified FOLFIRINOX as neoadjuvant chemotherapy for borderline resectable pancreatic cancer. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 28 patients diagnosed as borderline resectable pancreatic cancer who were admitted to the Tianjin Medical University Cancer Institute and Hospital between April 2013 and October 2015 were collected. Twenty-eight patients were treated with modified FOLFIRINOX( irinotecan 135 mg/m2, oxaliplatin 64 mg/m2, leucovorin 400 mg/m2, 5-FU 2 400 mg/m2, repeat the regimen every 2 weeks) as neoadjuvant chemotherapy. After the completion of neoadjuvant chemotherapy, patients were evaluated operation feasibility and developed surgical planning in 3 weeks. Observation indicators: (1) Efficacy of neoadjuvant chemotherapy; (2) adverse events of neoadjuvant chemotherapy; (3) surgical and postoperative situations; (4) follow-up situations. Follow-up using outpatient examination, telephone interview and we-chat was performed to etect survival of patients up to January 2017. Measurement data with skewed distribution were described as median (range). The survival curve was drawn by Kaplan-Meier method and the survival analysis was done by Log-rank test. Results (1) Efficacy of neoadjuvant chemotherapy: 28 patients received chemotherapy with a median cycle of 6 cycles (range, 3-12 cycles). Chemotherapy reaction of 28 patients: 14 had partial remission, 10 had stable disease and 4 had progressive disease. (2) Adverse events of neoadjuvant chemotherapy: there were 22 adverse events of 28 patients during chemotherapy, including 15 with grade1-2 and 7 with grade 3-4. (3) Surgical and postoperative situations: of 28 patients, 18 received radical resection for pancreatic cancer including 11 receiving pancreaticoduodenectomy, 7 receiving distal pancreatectomy with splenectomy. Surgeries included 6 with portal vein and superior mesenteric vein resection and reconstruction, 1 with coeliac trunk resection. Ten patients received R0 resection and 8 received R1 resection. Of 18 patients, 8 with postoperative complications were improved by conservative treatment, including 2 with pancreatic fistula, 1 with biliary fistula, 3 with delayed gastric empty, 1 with anastomotic hemorrhage, 1 with lympha fistula. No patient received re-operation or died within 30 days postoperatively. Pathological TNM staging: 2 patients were detected in stage Ⅰ-Ⅱ, 14 in stage Ⅲ and 2 in stage Ⅳ. All the 18 patients received chemotherapy after operation. Ten patients without operation continued chemotherapy. (4) Following up: 28 patients were followed up for 5-21 months with a median time of 13 months. Of the 15 died patients, 5 received operation and 10 received no operation. The median progression-free survival time and median overall survival time were 14 months and 19 months in the 18 operative patients, 7 months and 11 months in the 10 non-operative patients, respectively, with statistically significant differences (χ2=7.335, 9.950, P<0.05). Conclusions Modified FOLFIRINOX as neoadjuvant chemotherapy for borderline resectable pancreatic cancer is safe and effective, and patients can tolerate mild adverse reactions. Operable patients undergo surgeries after chemotherapy have relatively good outcome. Key words: Pancreatic neoplasm; Neoadjuvant chemotherapy; Modified FOLFIRINOX