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Annals of Surgical Oncology
Erschienen in:

03.01.2021 | Pancreatic Tumors

Intraoperative Radiation Mitigates the Effect of Microscopically Positive Tumor Margins on Survival Among Pancreatic Adenocarcinoma Patients Treated with Neoadjuvant FOLFIRINOX and Chemoradiation

verfasst von: Yurie Sekigami, MD, Theodoros Michelakos, MD, Carlos Fernandez-del Castillo, MD, Filippos Kontos, MD, Motaz Qadan, MD, PhD, Jennifer Y. Wo, MD, Jon Harrison, MD, Vikram Deshpande, MBBS, Onofrio Catalano, MD, Keith D. Lillemoe, MD, Theodore S. Hong, MD, Cristina R. Ferrone, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 8/2021

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Abstract

Background

Microscopically positive margins (R1) negatively impact survival in pancreatic ductal adenocarcinoma (PDAC). For patients with close/positive margins, intraoperative radiotherapy (IORT) can improve local control. The prognostic impact of an R1 resection in patients who receive total neoadjuvant therapy (TNT; FOLFIRINOX with chemoradiation) and IORT is unknown.

Methods

Clinicopathologic data were retrospectively collected for borderline/locally advanced (BR/LA) PDAC patients who received TNT and underwent resection between 2011 and 2019. Disease-free (DFS) and overall survival (OS) measured from time of diagnosis were compared between groups.

Results

Two hundred one patients received TNT and were resected, with a median DFS and OS of 24 months and 47 months, respectively. Eighty-eight patients (44%) received IORT; of these, 69 (78%) underwent an R0 and 19 (22%) an R1 resection. There was no significant difference in clinicopathologic factors between the IORT and no-IORT groups, except for resectability status (LA: IORT 69%, no-IORT 53%, p = 0.021) and surgeons’ concern for a positive/close margin. R1 resection was associated with worse DFS and OS in the no-IORT population. However, among patients who received IORT, there was no difference in DFS (R0: 29 months, IQR 14–47 vs R1: 20 months, IQR 15–28; p = 0.114) or OS (R0: 48 months, IQR 25-not reached vs R1: 37 months, IQR 30–47; p = 0.307) between patients who underwent R0 vs R1 resection. In multivariate analysis, within the IORT group, R1 resection was not associated with DFS or OS.

Conclusion

IORT may mitigate the adverse effect of an R1 resection on DFS and OS in BR/LA PDAC patients receiving TNT.
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Metadaten
Titel
Intraoperative Radiation Mitigates the Effect of Microscopically Positive Tumor Margins on Survival Among Pancreatic Adenocarcinoma Patients Treated with Neoadjuvant FOLFIRINOX and Chemoradiation
verfasst von
Yurie Sekigami, MD
Theodoros Michelakos, MD
Carlos Fernandez-del Castillo, MD
Filippos Kontos, MD
Motaz Qadan, MD, PhD
Jennifer Y. Wo, MD
Jon Harrison, MD
Vikram Deshpande, MBBS
Onofrio Catalano, MD
Keith D. Lillemoe, MD
Theodore S. Hong, MD
Cristina R. Ferrone, MD
Publikationsdatum
03.01.2021
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 8/2021
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-09444-z

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