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Downstaging in pancreatic cancer: A matched analysis of patients resected following systemic treatment of initially locally unresectable disease.

2011; Lippincott Williams & Wilkins; Volume: 29; Issue: 4_suppl Linguagem: Inglês

10.1200/jco.2011.29.4_suppl.257

1527-7755

Kai Bickenbach, Mithat Gönen, Murray F. Brennan, Michael I. D’Angelica, Ronald P. DeMatteo, Yuman Fong, William R. Jarnagin, Peter J. Allen,

Cancer Genomics and Diagnostics

257 Background: Patients with locally unresectable pancreatic cancer (AJCC stage III) have a median survival of 10–14 months. Standard treatment for these patients is systemic therapy with or without radiation. The objective of this study was to evaluate outcome of patients who respond to this treatment and undergo resection. Methods: Using a prospectively collected database (2000-2009), we identified patients who were initially deemed unresectable due to vascular invasion and had sufficient response to non-operative treatment to undergo resection (initial stage III). Overall survival (OS) was compared between this group and a matched group of patients who were resected during the same time period without receiving preoperative treatment (stage I and II). Case-matching was performed using a previously validated pancreatic cancer nomogram. Results: A total of 36 patients with initial stage III disease were identified who underwent resection after treatment with chemotherapy or radiation therapy. Initial unresectability was determined by operative exploration (n=15, 42%) or by cross-sectional imaging (n=21, 58%). All patients received chemotherapy prior to resection and 58% of patients received radiation. Resection consisted of pancreaticoduodenectomy (n=31, 86%), distal pancreatectomy (n=4, 11%), and total pancreatectomy (n=1, 3%). Pathology revealed T3 lesions in 27 patients (73%), nodal positivity in 6 patients (16%), and a negative margin in 30 patients (83%). There were no operative mortalities. Median follow-up was 13 months (range 2 to 44 months). The median OS in this series was 25 months from resection and 30 months since treatment initiation. There was no difference in OS from time of resection between the initial stage III patients and matched patients who presented with resectable disease (p=0.35). Conclusions: In this study, patients who were able to undergo resection following treatment of initial stage III pancreatic cancer experienced similar survival as those who presented with stage I and II disease. Resection is indicated in this highly select group of patients. No significant financial relationships to disclose.