Radiological and Surgical Implications of Neoadjuvant Treatment With FOLFIRINOX for Locally Advanced and Borderline Resectable Pancreatic Cancer

摘要: The prevalence of pancreatic adenocarcinoma (PDAC) continues to increase. American Cancer Society predicts 46,420 new cases and 39,590 deaths in the United States 2014. majority patients present with metastatic disease, whereas 30% locally advanced (LA) cancers.1 Unfortunately, overall survival (OS) cancer remains low, surgical resection offering only chance for potential cure. However, even then OS is reported be less than 20%.2–4 In hopes rendering LA PDAC resectable, combination chemotherapy often followed by 50.4 Gy radiation low-dose administered.5,6 However, historically 19% are rendered resectable.7–10 If an R0 can achieved, similar who considered resectable at presentation.9 these heavily treated have increased morbidity mortality.9,11 A significant breakthrough was achieved 2011 ACCORD trial.12 This trial demonstrated that fluorouracil, leucovorin, oxaliplatin, irinotecan (FOLFIRINOX) improved when compared gemcitabine (6.8 vs 11.1 months, P < 0.001).12 On basis encouraging results, FOLFIRINOX became a rational choice render resectable.13 Resectability determined radiologic imaging. most commonly used imaging modality stage triple-phase contrast-enhanced thin-slice (multidetector row) helical computed tomography 3-dimensional reconstructions. definitions borderline lesions vary significantly. ambiguity prompted 4 guideline statements from National Comprehensive Network, University Texas MD Anderson Center, Americas Hepato-Pancreato-Biliary Association (AHPBA)/Society Surgical Oncology (SSO)/Society Surgery Alimentary Tract (SSAT).14–17 These guidelines address vascular involvement, which major determinant unresectability. This study provides largest series neoadjuvantly underwent resection. Radiologic clinicopathologic features either or received neoadjuvant were exploration without treatment. first aim this critically evaluate accuracy determining resectability after chemoradiation. second compare outcomes results resections cohort FOLFIRINOX-treated no therapy.