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Advances in neoadjuvant therapy for resectable pancreatic cancer over the past two decades
Alvaro Gregorio Morales Taboad,Pablo Lozano Lominchar,Lorena Martin Roman,Pilar Garcia-Alfonso,Andres Jesus Munoz Martin,Jose Antonio Blanco Rodriguez,Jose Manuel Asencio Pascual 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.2
In the last two decades, pancreatic cancer has been undergoing important changes in its perioperative management due to the great interest in multidisciplinary management and preoperative multimodal therapy, which in numerous studies have shown promising clinical results. Although the standard of treatment for resectable pancreatic ductal adenocarcinoma (PDAC) today is surgery followed by adjuvant therapy, as it is a biologically aggressive disease, even with complete resection, it has high rates of local and distant relapse. Several retrospective and prospective phase I/II studies have opened the window for neoadjuvant therapy with chemotherapy (CT), chemoradiotherapy (CRT), or both, as an alternative treatment for resectable pancreatic cancer, with promising results. Neoadjuvant therapy could has some advantages, including early administration of systemic treatment, in vivo assessment of response to treatment, increase resectability rate in borderline patients, increase resection rate with negative margin and survival benefit. While it seems clear that even potentially resectable disease would benefit from preoperative multimodal therapy, the optimal neoadjuvant therapeutic strategy is still controversial and currently there are only recommendations for neoadjuvant treatment, in clinical guidelines such as the NCCN and ESMO, for borderline and/or locally advanced PDAC. This review provides an overview of recent studies available and how they relate to systemic treatment of resectable PDAC in the neoadjuvant setting.
Neoadjuvant therapy impact in early pancreatic cancer: “bioborderline” vs. “non-bioborderline”
Alvaro Gregorio Morales Taboad,Pablo Lozano Lominchar,Maria Fernandez Martinez,Pilar Garcia-Alfonso,Andres Munoz Martin,Jose Manuel Asencio 한국간담췌외과학회 2022 Annals of hepato-biliary-pancreatic surgery Vol.26 No.4
( Alvaro G. Morales Taboada ),( Jose Manuel Asencio Pascual ),( Pablo Lozano Lominchar ),( Jose Angel Lopez Baena ),( Enrique Velasco ),( Luis Rodriguez-bachiller ),( Benjamin Diaz Zorita ),( Arturo C 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: To analyze the impact of multimodal treatment strategy with neoadjuvant chemotherapy and intraoperative radiation therapy (IORT), on overall median survival in patients with pancreatic cancer. Methods: We analyzed 128 patients, from 1995 to 2016, who underwent multimodal treatment with and without neoadjuvant chemotherapy, surgery and intraoperative radiation therapy (IORT). The patients were stratified in two groups based in multimodality therapy. The data analyses were carried out using the chi-squared test, and the median survival was estimated according to the Kaplan-Meier method. Results: The mean age was 65 years, 71 men (55%) and 58 women (45%), the mean follow-up was 32.5 months with a median of 15.5 months. 19.5% received complete treatment and 41 patients were also treated with IORT, 23 patients (56.1%) were treated as part of the multimodal treatment versus 18 (43.9%), P=<0.001). The overall survival was 57.90 +/- 12.59 months for the neoadjuvant treatment group compared to 39.05 +/- 6.76 months in the control group without neoadjuvant treatment, (P=0, 05). IORT vs Not IORT was 62.05 +/- 13.34 months VS 38.65 +/- 6.58 months, P=0.027 respectively. Conclusions: Neoadjuvant and local therapy with intraoperative radiation therapy (IORT) are feasible strategies and associated with a longer overall median survival.