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CHEN Zegang, WANG Yongbing, OU Tao. Neoadjuvant Treatment of Borderline Resectable Pancreatic Cancer[J]. Cancer Research on Prevention and Treatment, 2022, 49(9): 982-986. DOI: 10.3971/j.issn.1000-8578.2022.22.0064
Citation: CHEN Zegang, WANG Yongbing, OU Tao. Neoadjuvant Treatment of Borderline Resectable Pancreatic Cancer[J]. Cancer Research on Prevention and Treatment, 2022, 49(9): 982-986. DOI: 10.3971/j.issn.1000-8578.2022.22.0064

Neoadjuvant Treatment of Borderline Resectable Pancreatic Cancer

Funding: 

Chongqing Science and Health Joint Medical Research Project 2021MSXM289

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  • Corresponding author:

    OU Tao, E-mail: 470444094@qq.com

  • Received Date: January 17, 2022
  • Revised Date: June 27, 2022
  • Available Online: January 12, 2024
  • Borderline resectable pancreatic ductal adenocarcinoma accounts for approximately 20% of newly diagnosed pancreatic cancer patients. This type of adenocarcinoma is between resectable and unresectable. It has a high degree of heterogeneity and features in anatomy, biology, and physical condition. The biological characteristics of invasiveness determine that, rather than direct surgery, neoadjuvant therapy should be primarily given to patients to achieve R0 resection and avoid early postoperative recurrence. However, this treatment model is still controversial. According to the latest research on this topic, the full text summarizes the definition of BR-PDAC, resectable evaluation, neoadjuvant treatment selection and evaluation, surgical results after neoadjuvant therapy, and the efficacy of adjuvant therapy after neoadjuvant therapy.

  • Competing interests: The authors declare that they have no competing interests.

  • [1]
    Mizrahi JD, Surana R, Valle JW, et al. Pancreatic cancer[J]. Lancet, 2020, 395(10242): 2008-2020. doi: 10.1016/S0140-6736(20)30974-0
    [2]
    Demir IE, Jäger C, Schlitter AM, et al. R0 Versus R1 Resection Matters after Pancreaticoduodenectomy, and Less after Distal or Total Pancreatectomy for Pancreatic Cancer[J]. Ann Surg, 2018, 268(6): 1058-1068. doi: 10.1097/SLA.0000000000002345
    [3]
    Kimura N, Yamada S, Takami H, et al. Optimal Preoperative Multidisciplinary Treatment in Borderline Resectable Pancreatic Cancer[J]. Cancers (Basel), 2020, 13(1): 36. doi: 10.3390/cancers13010036
    [4]
    Gillen S, Schuster T, Meyer zum Büschenfelde C, et al. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and metaanalysis of response and resection percentages[J]. PLoS Med, 2010, 7(4): e1000267. doi: 10.1371/journal.pmed.1000267
    [5]
    Katz MH, Shi Q, Ahmad SA, et al. Preoperative Modified FOLFIRINOX Treatment Followed by Capecitabine-Based Chemoradiation for Borderline Resectable Pancreatic Cancer: Alliance for Clinical Trials in Oncology Trial A021101[J]. JAMA Surg, 2016, 151(8): e161137. doi: 10.1001/jamasurg.2016.1137
    [6]
    Isaji S, Mizuno S, Windsor JA, et al. International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017[J]. Pancreatology, 2018, 18(1): 2-11. doi: 10.1016/j.pan.2017.11.011
    [7]
    Yamada S, Takami H, Sonohara F, et al. Effects of duration of initial treatment on postoperative complications in pancreatic cancer[J]. J Hepatobiliary Pancreat Sci, 2019, 26(6): 235-241. doi: 10.1002/jhbp.622
    [8]
    Versteijne E, Vogel JA, Besselink MG, et al. Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer[J]. Br J Surg, 2018, 105(8): 946-958. doi: 10.1002/bjs.10870
    [9]
    Paniccia A, Hosokawa P, Henderson W, et al. Characteristics of 10-year survivors of pancreatic ductal adenocarcinoma[J]. JAMA Surg, 2015, 150(8): 701-710. doi: 10.1001/jamasurg.2015.0668
    [10]
    Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer[J]. N Engl J Med, 2018, 379(25): 2395-2406. doi: 10.1056/NEJMoa1809775
    [11]
    Janssen QP, Buettner S, Suker M, et al. Neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer: a systematic review and patient-level meta-analysis[J]. J Natl Cancer Inst, 2019, 111(8): 782-794. doi: 10.1093/jnci/djz073
    [12]
    van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas[J]. N Engl J Med, 2010, 362(2): 129-137. doi: 10.1056/NEJMoa0903230
    [13]
    Kunzmann V, Siveke JT, Algül H, et al. Nab-paclitaxel plus gemcitabine versus nab-paclitaxel plus gemcitabine followed by FOLFIRINOX induction chemotherapy in locally advanced pancreatic cancer (NEOLAP-AIO-PAK-0113): a multicentre, randomised, phase 2 trial[J]. Lancet Gastroenterol Hepatol, 2021, 6(2): 128-138. doi: 10.1016/S2468-1253(20)30330-7
    [14]
    Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer[J]. N Engl J Med, 2011, 364(19): 1817-1825. doi: 10.1056/NEJMoa1011923
    [15]
    Paniccia A, Edil BH, Schulick RD, et al. Neoadjuvant FOLFIRINOX application in borderline resectable pancreatic adenocarcinoma: a retrospective cohort study[J]. Medicine (Baltimore), 2014, 93(27): e198. doi: 10.1097/MD.0000000000000198
    [16]
    Choi YJ, Byun Y, Kang JS, et al. Comparison of Clinical Outcomes of Borderline Resectable Pancreatic Cancer According to the Neoadjuvant Chemo-Regimens: Gemcitabine versus FOLFIRINOX[J]. Gut Liver, 2021, 15(3): 466-475. doi: 10.5009/gnl20070
    [17]
    Neoptolemos JP, Dunn JA, Stocken DD, et al. Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial[J]. Lancet, 2001, 358(9293): 1576-1585. doi: 10.1016/S0140-6736(01)06651-X
    [18]
    Chapman BC, Gleisner A, Rigg D, et al. Perioperative outcomes and survival following neoadjuvant stereotactic body radiation therapy (SBRT) versus intensity-modulated radiation therapy (IMRT) in pancreatic adenocarcinoma[J]. J Surg Oncol, 2018, 117(5): 1073-1083. doi: 10.1002/jso.25004
    [19]
    Stokes JB, Nolan NJ, Stelow EB, et al. Preoperative capecitabine and concurrent radiation for borderline resectable pancreatic cancer[J]. Ann Surg Oncol, 2011, 18(3): 619-627. doi: 10.1245/s10434-010-1456-7
    [20]
    Takai S, Satoi S, Yanagimoto H, et al. Neoadjuvant chemoradiation in patients with potentially resectable pancreatic cancer[J]. Pancreas, 2008, 36(1): e26-e32.
    [21]
    Cho IR, Chung MJ, Bang S, et al. Gemcitabine based neoadjuvant chemoradiotherapy therapy in patients with borderline resectable pancreatic cancer[J]. Pancreatology, 2013, 13(5): 539-543. doi: 10.1016/j.pan.2013.07.064
    [22]
    Katz MH, Marsh R, Herman JM, et al. Borderline resectable pancreatic cancer: need for standardization and methods for optimal clinical trial design[J]. Ann Surg Oncol, 2013, 20(8): 2787-2795. doi: 10.1245/s10434-013-2886-9
    [23]
    Christians KK, Tsai S, Mahmoud A, et al. Neoadjuvant FOLFIRINOX for borderline resectable pancreas cancer: a new treatment paradigm?[J]. Oncologist, 2014, 19(3): 266-274. doi: 10.1634/theoncologist.2013-0273
    [24]
    Dhir M, Malhotra GK, Sohal DPS, et al. Neoadjuvant treatment of pancreatic adenocarcinoma: a systematic review and meta-analysis of 5520 patients[J]. World J Surg Oncol, 2017, 15(1): 183. doi: 10.1186/s12957-017-1240-2
    [25]
    Nappo G, Donisi G, Zerbi A. Borderline resectable pancreatic cancer: Certainties and controversies[J]. World J Gastrointest Surg, 2021, 13(6): 516-528. doi: 10.4240/wjgs.v13.i6.516
    [26]
    Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic Adenocarcinoma, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology[J]. J Natl Compr Canc Netw, 2021, 19(4): 439-457. doi: 10.6004/jnccn.2021.0017
    [27]
    中华医学会外科学分会胰腺外科学组. 中国胰腺癌诊治指南(2021)[J]. 中华消化外科杂志, 2021, 59(7): 561-577. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK202107002.htm

    Pancreatic Surgery Group, Branch of Surgery, Chinese Medical Association. Guidelines for the diagnosis and treatment of pancreatic cancer in China(2021)[J]. Zhonghua Xiao Hua Wai Ke Za Zhi, 2021, 59(7): 561-577. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK202107002.htm
    [28]
    Cao F, Li J, Li A, et al. Prognostic significance of positive peritoneal cytology in resectable pancreatic cancer: a systemic review and meta-analysis[J]. Oncotarget, 2017, 8(9): 15004- 15013. doi: 10.18632/oncotarget.14745
    [29]
    Toesca DAS, Koong AJ, Poultsides GA, et al. Management of borderline resectable pancreatic cancer[J]. Int J Radiat Oncol Biol Phys, 2018, 100(5): 1155-1174. doi: 10.1016/j.ijrobp.2017.12.287
    [30]
    Ferrone CR, Marchegiani G, Hong TS, et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer[J]. Ann Surg, 2015, 261(1): 12-17. doi: 10.1097/SLA.0000000000000867
    [31]
    Katz MH, Pisters PW, Evans DB, et al. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease[J]. J Am Coll Surg, 2008, 206(5): 833-846. doi: 10.1016/j.jamcollsurg.2007.12.020
    [32]
    Katz MH, Fleming JB, Bhosale P, et al. Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators[J]. Cancer, 2012, 118(23): 5749-5756. doi: 10.1002/cncr.27636
    [33]
    Kaufmann B, Hartmann D, D'Haese JG, et al. Neoadjuvant Treatment for Borderline Resectable Pancreatic Ductal Adenocarcinoma[J]. Dig Surg, 2019, 36(6): 455-461. doi: 10.1159/000493466
    [34]
    Panda A, Garg I, Truty MJ, et al. Borderline Resectable and Locally Advanced Pancreatic Cancer: FDG PET/MRI and CT Tumor Metrics for Assessment of Pathologic Response to Neoadjuvant Therapy and Prediction of Survival[J]. AJR Am J Roentgenol, 2021, 217(3): 730-740. doi: 10.2214/AJR.20.24567
    [35]
    Hank T, Sandini M, Ferrone CR, et al. Association Between Pancreatic Fistula and Long-term Survival in the Era of Neoadjuvant Chemotherapy[J]. JAMA Surg, 2019, 154(10): 943-951. doi: 10.1001/jamasurg.2019.2272
    [36]
    Ecker BL, McMillan MT, Allegrini V, et al. Risk Factors and Mitigation Strategies for Pancreatic Fistula After Distal Pancreatectomy: Analysis of 2026 Resections From the International, Multi-institutional Distal Pancreatectomy Study Group[J]. Ann Surg, 2019, 269(1): 143-149. doi: 10.1097/SLA.0000000000002491
    [37]
    Takahashi H, Ogawa H, Ohigashi H, et al. Preoperative chemoradiation reduces the risk of pancreatic fistula after distal pancreatectomy for pancreatic adenocarcinoma[J]. Surgery, 2011, 150(3): 547-556. doi: 10.1016/j.surg.2011.03.001
    [38]
    Verma V, Li J, Lin C. Neoadjuvant Therapy for Pancreatic Cancer: Systematic Review of Postoperative Morbidity, Mortality, and Complications[J]. Am J Clin Oncol, 2016, 39(3): 302-313. doi: 10.1097/COC.0000000000000278
    [39]
    Kamarajah SK, Bundred JR, Boyle C, et al. Impact of neoadjuvant therapy on post-operative pancreatic fistula: a systematic review and meta-analysis[J]. ANZ J Surg, 2020, 90(11): 2201-2210. doi: 10.1111/ans.15885
    [40]
    Pietrasz D, Marthey L, Wagner M, et al. Pathologic Major Response After FOLFIRINOX is Prognostic for Patients Secondary Resected for Borderline or Locally Advanced Pancreatic Adenocarcinoma: An AGEO-FRENCH, Prospective, Multicentric Cohort[J]. Ann Surg Oncol, 2015, 22 Suppl 3: S1196-S1205.
    [41]
    Roland CL, Katz MH, Tzeng CW, et al. The Addition of Postoperative Chemotherapy is Associated with Improved Survival in Patients with Pancreatic Cancer Treated with Preoperative Therapy[J]. Ann Surg Oncol, 2015, 22 Suppl 3: S1221-S1228.
    [42]
    Barnes CA, Krepline AN, Aldakkak M, et al. Is Adjuvant Therapy Necessary for All Patients with Localized Pancreatic Cancer Who Have Received Neoadjuvant Therapy?[J]. J Gastrointest Surg, 2017, 21(11): 1793-1803. doi: 10.1007/s11605-017-3544-5
    [43]
    van Roessel S, Veldhuisen E, Klompmaker S, et al. Evaluation of Adjuvant Chemotherapy in Patients With Resected Pancreatic Cancer After Neoadjuvant FOLFIRINOX Treatment[J]. JAMA Oncol, 2020, 6(11): 1733-1740. doi: 10.1001/jamaoncol.2020.3537
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