Neoadjuvant chemo-radiotherapy for patients with borderline resectable pancreatic cancer: a meta-analytical evaluation of prospective studies.
BACKGROUND
For patients with borderline resectable pancreatic cancer, the benefit of neoadjuvant therapy remains to be defined.


OBJECTIVE
We did a systematic search of the literature on this topic.


METHODS
Prospective studies where chemotherapy with or without radiotherapy was given before surgery to patients with borderline resectable cancer, were analyzed by a meta-analytical approach.


METHODS
Primary outcome was surgical exploration and resection rates; tumor response, therapy-induced toxicity, and survival were secondary outcomes. Data were expressed as weighted pooled proportions with 95% confidence intervals (95% CI).


RESULTS
Ten studies with 182 participants were included. Following treatment, 69% of patients (95% CI: 56-80%) were brought to surgery and 80% (95% CI: 66-90%) of surgically-explored patients were resected. Eighty-three percent (95% CI: 74-90%) of resected specimens were deemed R0 resections. The weighted fractions of resected patients alive at 1 and 2 years were 61% (95% CI: 48-100%) and 44% (95% CI: 32-59%), respectively. At restaging following neoadjuvant therapy, weighted frequencies for complete/partial response were 16% (95% CI: 9-28%), 69% (95% CI: 60-76%) for stable disease, and 19% (95% CI: 13-25%) for progressive cancer. Treatment-related grade 3-4 toxicity was 32% (95% CI: 21-45%).


CONCLUSIONS
This meta-analysis shows that downstaging of the lesion following neoadjuvant therapies is uncommon for patients with borderline resectable pancreatic cancer. A clear benefit of this regimen could be to spare surgery to patients with progressive disease during the frame-time chemo-radiotherapy is being delivered.
Division of Gastroenterology, "San Filippo Neri" Hospital. Rome, Italy. v.festa@sanfilipponeri.roma.it.
Virginia
V
Festa
Angelo
A
Andriulli
Maria Rosaria
MR
Valvano
Generoso
G
Uomo
Francesco
F
Perri
Nicola
N
Andriulli
Salvatore
S
Corrao
Maurizio
M
Koch
D059248:Chemoradiotherapy; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010190:Pancreatic Neoplasms / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D016019:Survival Analysis