title: Preoperative FOLFIRINOX for borderline resectable pancreatic cancer: Is radiation necessary in the modern era of chemotherapy?
abstract: BACKGROUND
  No consensus exists regarding the optimal neoadjuvant treatment paradigm for patients with borderline resectable pancreatic cancer (BRPC), including the respective roles of chemotherapy and radiation.
  
  
  METHODS
  We performed a retrospective analysis, including detailed pathologic and radiologic review, of pancreatic cancer patients undergoing FOLFIRINOX, with or without radiation therapy (RT), prior to surgical resection at a high-volume academic center over a 4-year period.
  
  
  RESULTS
  Of 26 patients meeting inclusion criteria, 22 (84.6%) received FOLFIRINOX alone without RT (median number of treatment cycles = 9). The majority of patients met formal radiographic criteria for BRPC, with the superior mesenteric vein representing the most common vessel involved. R0 resection rate was 90.9%, with 12 patients (54.5%) requiring vascular reconstruction. Treatment response was classified as moderate or marked in 16 patients (72.7%) according to the College of American Pathologists grading system. Estimated median disease-free and overall survival rates are 22.6 months and not reached (NR), respectively.
  
  
  CONCLUSIONS
  This is one of the largest series to describe the use of neoadjuvant FOLFIRINOX, without radiation therapy, in patients with BRPC undergoing surgical resection. Given the high R0 resection rates and favorable clinical outcomes with chemotherapy alone, this strategy should be further assessed in prospective study design. J. Surg. Oncol. 2016;114:587-596. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Hematology/Oncology, University of California San Francisco, San Francisco, California.
authors.forename: Sunhee S
authors.initials: SS
authors.lastname: Kim
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, California. eric.nakakura@ucsf.edu.
authors.forename: Eric K
authors.initials: EK
authors.lastname: Nakakura
authors.affiliation: Department of Radiology, University of California San Francisco, San Francisco, California.
authors.forename: Zhen J
authors.initials: ZJ
authors.lastname: Wang
authors.affiliation: Department of Pathology, University of California San Francisco, San Francisco, California.
authors.forename: Grace E
authors.initials: GE
authors.lastname: Kim
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Carlos U
authors.initials: CU
authors.lastname: Corvera
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Hobart W
authors.initials: HW
authors.lastname: Harris
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Kimberly S
authors.initials: KS
authors.lastname: Kirkwood
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Hirose
authors.affiliation: Division of Hematology/Oncology, University of California San Francisco, San Francisco, California.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Tempero
authors.affiliation: Division of Hematology/Oncology, University of California San Francisco, San Francisco, California. andrewko@medicine.ucsf.edu.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Ko
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D002166:Camptothecin / Q000031:analogs & derivatives*; D059186:Chemoradiotherapy, Adjuvant; D005472:Fluorouracil; D006801:Humans; D002955:Leucovorin; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009944:Organoplatinum Compounds; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018579:Patient Selection; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
keywords: FOLFIRINOX; borderline resectable; neoadjuvant; pancreatic cancer