Intention to treat outcomes among patients with pancreatic cancer treated using International Study Group on Pancreatic Surgery recommended pathways for resectable and borderline resectable disease.
Kamarajah, Sivesh K Chatzizacharias, Nikolaos Hodson, James Marcon, Francesca Kalisvaart, Marit Punia, Pankaj Ting Ma, Yuk Dasari, Bobby Marudanayagam, Ravi Sutcliffe, Robert P
Kamarajah, Sivesh K
Chatzizacharias, Nikolaos
Hodson, James
Marcon, Francesca
Kalisvaart, Marit
Punia, Pankaj
Ting Ma, Yuk
Dasari, Bobby
Marudanayagam, Ravi
Sutcliffe, Robert P
Abstract
Background: The International Study Group on Pancreatic Surgery recommends upfront surgery for resectable pancreatic cancer or borderline resectable-venous (BR-V) disease and neoadjuvant therapy (NAT) among those with arterial involvement (BR-A or locally advanced, LA). Though neoadjuvant therapy (NAT) is a promising strategy, outcomes are rarely reported on intention-to-treat (ITT) basis. This study presents ITT outcomes where pathways to surgery were in line with International Study Group on Pancreatic Surgery guidelines.
Methods: Patients recommended for potentially curative treatment with PDAC between 2012 and 2017 (n = 345) were classified as resectable, BR-A/BR-V or LA, according to NCCN criteria. The primary outcome was overall survival. Secondary outcomes were resection rates, positive margins and toxicity among patients receiving NAT.
Results: At surgery, the resection rates were 78% (172/221), 65% (35/54) and 54% (21/39) for those with resectable, BR-V and BR-A/LA disease, respectively (P < 0.0001). The median survival of those resected in the BR-A/LA cohort was 31 months. However, on an ITT basis, there was no significant difference in survival between resectable, BR-V and BR-A/LA disease (median: 19 versus 15 versus 19 months; P = 0.585). On review, some 31 (44%) patients of the BR-A/LA cohort either did not receive or did not complete NAT.
Conclusion: To realize benefits of NAT, more patients need to complete NAT and to undergo resection. Upfront resection for BR-V disease is associated with equivalent outcomes to upfront surgery for resectable disease or NAT for BR-A/LA disease. Strategies to increase the proportion of patients who complete NAT and undergo resection are needed.
MIDER Authors
Chatzizacharias, Nikolaos
Dasari, Bobby
Marudanayagam, Ravi
Sutcliffe, Robert P
Isaac, John
Roberts, Keith J
Ma, Yuk Ting
Dasari, Bobby
Marudanayagam, Ravi
Sutcliffe, Robert P
Isaac, John
Roberts, Keith J
Ma, Yuk Ting
Affiliations
Citations
Altmetric:
Date
2021-02-12
Type
Article
Subject
Collections
Citation
Kamarajah SK, Chatzizacharias N, Hodson J, Marcon F, Kalisvaart M, Punia P, Ting Ma Y, Dasari B, Marudanayagam R, Sutcliffe RP, Muiesan P, Mirza DF, Isaac J, Roberts KJ. Intention to treat outcomes among patients with pancreatic cancer treated using International Study Group on Pancreatic Surgery recommended pathways for resectable and borderline resectable disease. ANZ J Surg. 2021 Jul;91(7-8):1549-1557. doi: 10.1111/ans.16643. Epub 2021 Feb 12