Abstract
Background: The value of neoadjuvant radiotherapy (RT) after 5-fluo-rouracil 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 TransAtlantic 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 (P5.71). RT was associated with a lower resection rate (55.3% vs 72.7%; P5.002). In patients who underwent a resection, RT was associated with a comparable margin-negative resection rate (.1 mm) (70.6% vs 64.8%; P5.51), more node-negative disease (57.3% vs 37.6%; P5.01), and more major pathologic response with,5% tumor viability (24.7% vs 8.3%; P5.006). The OS associated with conventional and stereotactic body RT approaches was similar (median OS, 25.7 vs 26.0 months; P5.92). 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.
| Original language | English |
|---|---|
| Pages (from-to) | 783-791 |
| Number of pages | 9 |
| Journal | Journal of the National Comprehensive Cancer Network : JNCCN |
| Volume | 20 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - Jul 2022 |
Bibliographical note
Funding Information:The authors thank Caitlin McIntyre, MD; Sarah McIntyre, MD: Crisanta Ilagan, MD; and Dana Haviland, Mrs, for helping with the data collection, and thank Joost J.M.E. Nuyttens, MD, PhD; Timothy E. Newhook, MD; Annissa Desilva, Ms; Thomas F. Stoop, MD; and Rutger Theijse, Mr, who all critically reviewed and revised the article. The authors also acknowledge the Living With Hope Foundation, the Onno Ruding Foundation, the Dutch Cancer Society, and ZonMw for their financial support.
Funding Information:
Funding: Research reported in this article was supported by KWF Kankerbestrijding (10955), ZonMW (843004108), Living with Hope Foundation, Vereniging Trustfonds Erasmus Universiteit Rotterdam, and NIH/NCI Cancer Center Support Grant P30 CA008748 (Dr. O’Reilly).
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