Borderline Pancreatic Adenocarcinoma Research Articles

The involvement of the hepatic artery is a risk factor for unresectability after neoadjuvant treatment in borderline pancreatic adenocarcinoma

IntroductionBorderline Resectable Pancreatic Ductal Adenocarcinoma (BR-PDAC) benefits from neoadjuvant treatment (NAT) with the intent of surgical salvage in the absence of disease progression during chemotherapy (CT) or chemoradiotherapy (CRT). Scarce literature exists about prognostic factors of resectability at the time of diagnosis or during neoadjuvant treatment, especially regarding vascular relationships. MaterialsWe reviewed our prospective BR-PDAC cohort to determine resectability predictors. We collected data about clinical baseline characteristics, vessels’ involvement, type of NAT, CA19-9 evolution, and radiological outcome. We performed a descriptive analysis and a logistic regression model to define resectability predictors; we finally compared overall survival (OS) and progression-free survival (PFS) for those predictors. ResultsOne hundred patients started NAT, with a resection rate of 44 % (40 pancreaticoduodenectomies, 4 distal pancreatectomies). The most frequent vessel relationship was the abutment of the superior mesenteric artery (44 %), and 26 patients had ≥2 vessels involved. Prognostic factors of resectability were CA19-9 response >10 % (OR 3.07, p = 0.016) and Hepatic Artery involvement (OR 0.21, p = 0.026). Median overall survival was better for CA19-9 responders than for non-responders (20.9 months and 11.8 months respectively, p < 0.001), and similar to normalized CA19-9 (25.0 months, p = 0.48). There were no differences in terms of OS or PFS with the involvement of the HA (17.7 vs 17.1 months, p = 0.367; and 8.7 vs 12.0 months, p = 0.267). ConclusionThe involvement of the Hepatic Artery seems to confer a worse prognosis regarding resectability. A decrease of only >10 % of CA19-9 is a predictive factor for resectability and better overall and progression-free survival.

Application of the RECIST Thresholds to the Carbohydrate Antigen 19-9 Variation after FOLFIRINOX Induction for Borderline Pancreatic Adenocarcinoma

Application of the RECIST Thresholds to the Carbohydrate Antigen 19-9 Variation after FOLFIRINOX Induction for Borderline Pancreatic Adenocarcinoma

Cancer-specific Survival and Risk Factors of Progression in Resected Borderline Pancreatic Adenocarcinoma

Cancer-specific Survival and Risk Factors of Progression in Resected Borderline Pancreatic Adenocarcinoma

Cytokines and Lymphoid Populations as Potential Biomarkers in Locally and Borderline Pancreatic Adenocarcinoma.

Despite its relative low incidence, PDAC is one of the most aggressive and lethal types of cancer, being currently the seventh leading cause of cancer death worldwide, with a 5-year survival rate of 10.8%. Taking into consideration the necessity to improve the prognosis of these patients, this research has been focused on the discovery of new biomarkers. For this purpose, patients with BL and resectable disease were recruited. Serum cytokines and growth factors were monitored at different time points using protein arrays. Immune cell populations were determined by flow cytometry in peripheral blood as well as by immunohistochemistry (IHC) in tumor tissues. Several cytokines were found to be differentially expressed between the study subgroups. In the BL disease setting, two different scores were proven to be independent prognostic factors for progression-free survival (PFS) (based on IL-10, MDC, MIF, and eotaxin-3) and OS (based on eotaxin-3, NT-3, FGF-9, and IP10). In the same context, CA19-9 was found to play a role as independent prognostic factor for OS. Eotaxin-3 and MDC cytokines for PFS, and eotaxin-3, NT-3, and CKβ8-1 for OS, were shown to be predictive biomarkers for nab-paclitaxel and gemcitabine regimen. Similarly, oncostatin, BDNF, and IP10 cytokines were proven to act as predictive biomarkers regarding PFS, for FOLFIRINOX regimen. In the resectable cohort, RANTES, TIMP-1, FGF-4, and IL-10 individually differentiated patients according to their cancer-associated survival. Regarding immune cell populations, baseline high levels of circulating B lymphocytes were related to a significantly longer OS, while these levels significantly decreased as progression occurred. Similarly, baseline high levels of helper lymphocytes (CD4+), low levels of cytotoxic lymphocytes (CD8+), and a high CD4/CD8 ratio, were related to a significantly longer PFS. Finally, high levels of CD4+ and CD8+ intratumoural infiltration was associated with significantly longer PFS. In conclusion, in this study we were able to identify several prognostic and predictive biomarker candidates in patients diagnosed of resectable or BL PDAC.

Multidisciplinary approach for Borderline pancreatic adenocarcinoma of the head of the pancreas

Background: Borderline pancreatic adenocarcinoma (BPAC) may be technically resectable with high risks of R1 resection and postoperative recurrence. Neoadjuvant chemotherapy (NAC) is used without clear consensus. We present the preliminary Results of multidisciplinary management of BPAC patients Methods: We adopted the definition of the National Comprehensive Cancer Network (NCCN) for BPAC. All patients received neoadjuvant chemotherapy with at minimum 4 cures. The goal of this study was to investigate the morbidity and survival after surgical resection depending on the quality of oncological resection. Results: From September 2012 to December 2018,120 patients underwent pancreaticoduodenectomy (PD) for adenocarcinoma of the head of the pancreas. Among them, 34 (28%) had BPAC. Vascular resection was performed in 32% of patient. R0 resection was achieved in 56% of cases and R1 in 44%. According to surgical margin, R1 resections were divided into R1 0mm (54%) and R1 low ]0,1 mm[ (46%) Ninety-day mortality was nil. A pancreatic fistula occurred in 6% of patients. In terms of survival, overall (p=0.71) and recurrence-free (P=0.32) survival were similar to those in patients with resectable tumors. Same findings were noted between R0 et R1 low (p=0.72). Survival was statistically lower in the group R1 0mm when compared to survival of R0 group (P=0.05). Conclusions: Using a multidisciplinary approach to manage BPAC, good outcome could be achieved. Oncological quality of resection with at least R1 low resection is of paramount importance to ensure optimal survival.

Portal-Mesenteric Vein Resection in Borderline Pancreatic Cancer; 33 Month-Survival in Patients with Good Performance Status.

Background: Patients with pancreatic cancer (PC), which is not upfront resectable, but borderline, involving major peripancreatic vessels, have not been generally considered for surgery, considering that resection in such a setting may be futile.Materials and Methods: Retrospective analysis of prospectively collected data on patients with borderline pancreatic adenocarcinoma undergoing pancreatectomy en-block with portal and/or superior mesenteric vein resection in a tertiary referral center in Greece between January 2012 and February 2017. Follow-up was complete up to January 2018.Results: Twenty-four patients were included. Neoadjuvant therapy (NAT) was administered to only 38%, but more commonly in the second half of the group (58% vs. 17%, p = 0.035). It was associated with smaller tumor size (median: 2.5 vs. 4.2 cm, p < 0.001), fewer positive lymph nodes (LNs) in the resected specimen (median: 2 vs. 5, p = 0.04), and higher likelihood of adjuvant therapy (78% vs. 40%, p = 0.01), but not with survival. Resection was extensive: a median of 26 LNs were retrieved, R0 resection rate (≥1 mm) was 79%, and median length of vein segments was 4 cm, requiring interposition grafts in 58% (mostly polytetrafluoroethylene). Median intensive care unit stay was 0 days and length of hospital stay was 9 days. Post-operative mortality was 12.5%. Median overall survival was 24 months. Eastern Cooperative Oncology Group (ECOG) status was significantly associated with survival (p < 0.001) with ECOG-0: 33 months, ECOG-1: 12 months, and ECOG-2: 6 months.Conclusion: This first Greek national series of portomesenteric vein resection in borderline PC demonstrates that it results to 2 years of median survival, extending to 33 months in patients with good performance status, especially if NAT is uniformly administered.

Neoadjuvant gemcitabine-oxaliplatin (GemOx) combination followed by chemoradiotherapy (CRT) in borderline pancreatic adenocarcinoma (BPC): A promising management

Olivia Hentic , Dokmak Safi , Cros Jerome , Zappa Magaly , Rebours Vinciane , Gaujoux Sebastien , Maire Frederique , Couvelard Anne , Levy Philippe , Ruszniewski Philippe , Sauvanet Alain , Hammel Pascal 1 Hopital Beaujon, Gastroent erologie, France Hopital Beaujon, Chirurgie Pancreatique, France Hopital Beaujon, Anatomopathologie, France Hopital Beaujon, Radiologie, France 5 hopital Bichat, Pathologie, France

Gemcitabine-oxaliplatin (GemOx) combination followed by chemoradiotherapy (CRT) in borderline pancreatic adenocarcinoma (BPC).

e15231 Background: Whereas BPC is potentially resectable, the risks of incomplete (R1) resection or early progression are high. Tumor response rate using GemOx in metastatic setting was of 27% with safety profile and CRT increase the rate of R0 resections. Aim: To evaluate feasibility and efficacy of a neoadjuvant therapy with GemOx+CRT in patients (pts) with BPC according to the MD Anderson classification. Methods: In this retrospective monocentric study, all eligible pts (PS<2, no contraindication for surgery) received 2 months of GemOx (gemcitabine 1000mg/m² D1, oxaliplatin 85 mg/m² D2, D1=D14); then, CRT (54 Gy+capecitabine) was administered in pts with tumor control. 2ndevaluation was done 1 month later to evaluate tumor resecability. Rate of treatment completion and resection, pathological response and disease free (DFS) and overall survival (OS) were analysed. Results: From 06/05 to 05/13, 72 pts (M= 38 [53%], median age 63 [42-80] yrs) received a median of 5[3-8] GemOx. After 1stevaluation, 17(24%...

A Systematic Review of Neoadjuvant Therapy Compared to the “Resection First” Approach for Patients with Borderline Resectable Pancreatic Adenocarcinoma

Background: Survival for patients with pancreatic adenocarcinoma continues to be poor. Patients with pancreatic adenocarcinoma that is deemed borderline resectable have imaging that shows disease involvement of the portal vein and/or superior mesenteric vein that is amenable to reconstruction or abutment (≤180 degrees) of the superior mesenteric artery. The best initial treatment for patients with borderline resectable pancreatic adenocarcinoma has yet to be determined. Proponents of neoadjuvant therapy purport its utility for patients with borderline resectable pancreatic adenocarcinoma with the intention of increasing the likelihood of a microscopically negative (R0) margin, but the consequences of this approach are not established. This study was undertaken to systematically review the outcomes for patients with borderline resectable pancreatic adenocarcinoma to compare neoadjuvant therapy to a “resection first” approach. Methods: A MEDLINE/PubMed search was undertaken to find all studies regarding patients who underwent neoadjuvant therapy for patients with borderline resectable pancreatic adenocarcinoma. Results: A total of 112 studies were found regarding borderline resectable pancreatic cancer. Fourteen studies contained cohorts of patients with borderline resectable pancreatic adenocarcinoma who received neoadjuvant therapy (n = 471 patients) or a resection-first approach (n = 76 patients). Resection after neoadjuvant therapy was undertaken for 233 (49%) patients. Neoadjuvant therapy followed by an R0 resection occurred for 42% of patients. For patients who underwent resection first, 71% (54/76) had an R0 margin. Conclusion: Patients with borderline resectable pancreatic adenocarcinoma were more often found to undergo neoadjuvant therapy than a “resection first” approach in the available literature. Although neoadjuvant therapy portends a high rate of R0 resections, less than half of the patients who undergo neoadjuvant therapy for borderline resectable pancreatic adenocarcinoma undergo resection. Patients who undergo “resection first” for borderline resectable pancreatic adenocarcinoma have an increased chance for a resection and an R0 margin compared to patients who undergo neoadjuvant therapy for borderline pancreatic adenocarcinoma.

Neoadjuvant chemoradiation therapy for borderline pancreatic adenocarcinoma: report of two cases

Pancreatic cancer remains as one of the most aggressive human neoplasms, with overall poor survival rates. Radical surgery of the primary lesion is the best option for treatment. Borderline resectable pancreatic tumors (BRPT), defined as partial involvement of peripancreatic vasculature, may benefit from neoadjuvant therapy. We report on the first two BRPT cases treated with neoadjuvant chemoradiation at our institution. Preoperative CT and MRI demonstrated pancreatic tumors encasing the porto-mesenteric confluence suggestive of BRPT. Patients received neoadjuvant chemotherapy (gemcitabine/cisplatin), followed by radiochemotherapy. After treatment, follow-up images demonstrated tumor downsize, allowing for the tumors to be considered then as resectable. They underwent partial pancreatoduodenectomies (Whipple procedure). In case 1, histopathology revealed a complete, margin-free resection, whereas in case 2 there was a complete pathological response, with no evidence of residual tumor. According to the literature, our initial experience using neoadjuvant chemoradiotherapy on BRPT allowed us to downsize the tumor and, subsequently, to perform a curative surgery.

Chemoradiation followed by chemotherapy before resection for borderline pancreatic adenocarcinoma

Background For patients with borderline resectable pancreatic cancer, preoperative chemoradiation and standalone chemotherapy may allow for R0 resection and improved survival. Methods A retrospective review of patients with borderline resectable pancreatic cancer treated with preoperative chemoradiation and standalone chemotherapy was undertaken. Clinical variables, including disease-free and overall survival, were collected. Univariate analysis was used to identify factors impacting survival. Results Thirteen patients with borderline resectable pancreatic cancer were treated with preoperative chemoradiation and chemotherapy. Morbidity and mortality were 38% and 0. There were 2 R1 and 11 R0 resections. Nine patients are alive with a median follow-up of 20 months. Five patients recurred at a median of 4 months. Tumor fibrosis ≤60% was associated with recurrence and poor survival. Conclusions Preoperative chemoradiation and chemotherapy allow a select group of patients with borderline resectable pancreatic cancer to undergo an R0 or R1 resection with acceptable morbidity and mortality. Tumor response may be associated with survival.