title: Systematic Review of Resection Rates and Clinical Outcomes After FOLFIRINOX-Based Treatment in Patients with Locally Advanced Pancreatic Cancer.
abstract: FOLFIRINOX prolongs survival in patients with metastatic pancreatic cancer and may also benefit patients with locally advanced pancreatic cancer (LAPC). Furthermore, it may downstage a proportion of LAPC into (borderline) resectable disease, however data are lacking. This review assessed outcomes after FOLFIRINOX-based therapy in LAPC.
  
  
  
  The PubMed, EMBASE and Cochrane library databases were systematically searched for studies published to 31 August 2015. Primary outcome was the (R0) resection rate.
  
  
  
  Fourteen studies involving 365 patients with LAPC were included; three studies administered a modified FOLFIRINOX regimen. Of all patients, 57 % (n = 208) received radiotherapy. The pooled resection rate was 28 % (n = 103, 77 % R0), with a perioperative mortality of 3 % (n = 2), and median overall survival ranged from 8.9 to 25.0 months. Survival data after resection were scarce, with only one study reporting a median overall survival of 24.9 months in 28 patients. A complete pathologic response was found in 6 of 85 (7 %) resected specimens. Dose reductions were described in up to 65 % of patients, grade 3-4 toxicity occurred in 23 % (n = 51) of patients, and 2 % (n = 5) had to discontinue treatment. Data of patients treated solely with FOLFIRINOX, without additional radiotherapy, were available from 292 patients: resection rate was 12 % (n = 29, 70 % R0), with 15.7 months median overall survival and 19 % (n = 34) grade 3-4 toxicity.
  
  
  
  Outcomes after FOLFIRINOX-based therapy in patients with LAPC seem very promising but further prospective studies are needed, especially with regard to survival after resection.
authors.affiliation: Department of Surgery, University Medical Centre Utrecht Cancer Center, Utrecht, The Netherlands.
authors.forename: Steffi J
authors.initials: SJ
authors.lastname: Rombouts
authors.affiliation: Department of Surgery, University Medical Centre Utrecht Cancer Center, Utrecht, The Netherlands.
authors.forename: Marieke S
authors.initials: MS
authors.lastname: Walma
authors.affiliation: Department of Surgery, G4-196, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Jantien A
authors.initials: JA
authors.lastname: Vogel
authors.affiliation: Department of Surgery, G4-196, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Lennart B
authors.initials: LB
authors.lastname: van Rijssen
authors.affiliation: Department of Medical Oncology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Johanna W
authors.initials: JW
authors.lastname: Wilmink
authors.affiliation: Department of Medical Oncology, University Medical Centre Utrecht Cancer Center, Utrecht, The Netherlands.
authors.forename: Nadia Haj
authors.initials: NH
authors.lastname: Mohammad
authors.affiliation: Department of Surgery, G4-196, Academic Medical Centre, Amsterdam, The Netherlands.|Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.affiliation: Department of Surgery, University Medical Centre Utrecht Cancer Center, Utrecht, The Netherlands.
authors.forename: I Quintus
authors.initials: IQ
authors.lastname: Molenaar
authors.affiliation: Department of Surgery, G4-196, Academic Medical Centre, Amsterdam, The Netherlands. m.g.besselink@amc.uva.nl.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D018395:CA-19-9 Antigen / Q000097:blood; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin / Q000008:administration & dosage; D020360:Neoadjuvant Therapy; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000097:blood / Q000628:therapy*; D011878:Radiotherapy; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate
chemical_list: D018395:CA-19-9 Antigen; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin