TY - JOUR
T1 - Added Value of Radiotherapy Following Neoadjuvant FOLFIRINOX for Resectable and Borderline Resectable Pancreatic Cancer
T2 - A Systematic Review and Meta-Analysis
AU - Janssen, Quisette P.
AU - van Dam, Jacob L.
AU - Kivits, Isabelle G.
AU - Besselink, Marc G.
AU - van Eijck, Casper H. J.
AU - Homs, Marjolein Y. V.
AU - Nuyttens, Joost J. M. E.
AU - Qi, Hongchao
AU - van Santvoort, Hjalmar J.
AU - Wei, Alice C.
AU - de Wilde, Roeland F.
AU - Wilmink, Johanna W.
AU - van Tienhoven, Geertjan
AU - Groot Koerkamp, Bas
N1 - Funding Information: This study is supported by the Dutch Cancer Society (10955) and by ZonMw (843004108). No funding agency was involved in the design of the study, or the collection, analysis, and interpretation of data. The authors are solely responsible for the content of the study and do not necessarily represent the viewpoint of the Dutch Cancer Society or ZonMw. Funding Information: The authors wish to thank W. Bramer from the Erasmus MC Medical Library for developing and updating the search strategies, and the Dutch Cancer Society and ZonMw for their financial support. Publisher Copyright: © 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - Background: The added value of radiotherapy following neoadjuvant FOLFIRINOX chemotherapy in patients with resectable or borderline resectable pancreatic cancer ((B)RPC) is unclear. The objective of this meta-analysis was to compare outcomes of patients who received neoadjuvant FOLFIRINOX alone or combined with radiotherapy. Methods: A systematic literature search was performed in Embase, Medline (ovidSP), Web of Science, Scopus, Cochrane, and Google Scholar. The primary endpoint was pooled median overall survival (OS). Secondary endpoints included resection rate, R0 resection rate, and other pathologic outcomes. Results: We included 512 patients with (B)RPC from 15 studies, of which 7 were prospective nonrandomized studies. In total, 351 patients (68.6%) were treated with FOLFIRINOX alone (8 studies) and 161 patients (31.4%) were treated with FOLFIRINOX and radiotherapy (7 studies). The pooled estimated median OS was 21.6 months (range 18.4–34.0 months) for FOLFIRINOX alone and 22.4 months (range 11.0–37.7 months) for FOLFIRINOX with radiotherapy. The pooled resection rate was similar (71.9% vs. 63.1%, p = 0.43) and the pooled R0 resection rate was higher for FOLFIRINOX with radiotherapy (88.0% vs. 97.6%, p = 0.045). Other pathological outcomes (ypN0, pathologic complete response, perineural invasion) were comparable. Conclusions: In this meta-analysis, radiotherapy following neoadjuvant FOLFIRINOX was associated with an improved R0 resection rate as compared with neoadjuvant FOLFIRINOX alone, but a difference in survival could not be demonstrated. Randomized trials are needed to determine the added value of radiotherapy following neoadjuvant FOLFIRINOX in patients with (B)PRC.
AB - Background: The added value of radiotherapy following neoadjuvant FOLFIRINOX chemotherapy in patients with resectable or borderline resectable pancreatic cancer ((B)RPC) is unclear. The objective of this meta-analysis was to compare outcomes of patients who received neoadjuvant FOLFIRINOX alone or combined with radiotherapy. Methods: A systematic literature search was performed in Embase, Medline (ovidSP), Web of Science, Scopus, Cochrane, and Google Scholar. The primary endpoint was pooled median overall survival (OS). Secondary endpoints included resection rate, R0 resection rate, and other pathologic outcomes. Results: We included 512 patients with (B)RPC from 15 studies, of which 7 were prospective nonrandomized studies. In total, 351 patients (68.6%) were treated with FOLFIRINOX alone (8 studies) and 161 patients (31.4%) were treated with FOLFIRINOX and radiotherapy (7 studies). The pooled estimated median OS was 21.6 months (range 18.4–34.0 months) for FOLFIRINOX alone and 22.4 months (range 11.0–37.7 months) for FOLFIRINOX with radiotherapy. The pooled resection rate was similar (71.9% vs. 63.1%, p = 0.43) and the pooled R0 resection rate was higher for FOLFIRINOX with radiotherapy (88.0% vs. 97.6%, p = 0.045). Other pathological outcomes (ypN0, pathologic complete response, perineural invasion) were comparable. Conclusions: In this meta-analysis, radiotherapy following neoadjuvant FOLFIRINOX was associated with an improved R0 resection rate as compared with neoadjuvant FOLFIRINOX alone, but a difference in survival could not be demonstrated. Randomized trials are needed to determine the added value of radiotherapy following neoadjuvant FOLFIRINOX in patients with (B)PRC.
UR - http://www.scopus.com/inward/record.url?scp=85108159691&partnerID=8YFLogxK
U2 - https://doi.org/10.1245/s10434-021-10276-8
DO - https://doi.org/10.1245/s10434-021-10276-8
M3 - Article
C2 - 34142290
SN - 1068-9265
VL - 28
SP - 8297
EP - 8308
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 13
ER -