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Open Access 01-01-2021 | Pancreatic Cancer | Original Article

R0 resection following chemo (radio)therapy improves survival of primary inoperable pancreatic cancer patients. Interim results of the German randomized CONKO-007± trial

Authors: Prof. Dr. R. Fietkau, R. Grützmann, U. A. Wittel, R. S. Croner, L. Jacobasch, U. P. Neumann, A. Reinacher-Schick, D. Imhoff, S. Boeck, L. Keilholz, H. Oettle, W. M. Hohenberger, H. Golcher, W. O. Bechstein, W. Uhl, A. Pirkl, W. Adler, S. Semrau, S. Rutzner, M. Ghadimi, D. Lubgan

Published in: Strahlentherapie und Onkologie | Issue 1/2021

Abstract

Purpose

Chemotherapy with or without radiotherapy is the standard in patients with initially nonmetastatic unresectable pancreatic cancer. Additional surgery is in discussion. The CONKO-007 multicenter randomized trial examines the value of radiotherapy. Our interim analysis showed a significant effect of surgery, which may be relevant to clinical practice.

Methods

One hundred eighty patients received induction chemotherapy (gemcitabine or FOLFIRINOX). Patients without tumor progression were randomized to either chemotherapy alone or to concurrent chemoradiotherapy. At the end of therapy, a panel of five independent pancreatic surgeons judged the resectability of the tumor.

Results

Following induction chemotherapy, 126/180 patients (70.0%) were randomized to further treatment. Following study treatment, 36/126 patients (28.5%) underwent surgery; (R0: 25/126 [19.8%]; R1/R2/Rx [n = 11/126; 6.1%]). Disease-free survival (DFS) and overall survival (OS) were significantly better for patients with R0 resected tumors (median DFS and OS: 16.6 months and 26.5 months, respectively) than for nonoperated patients (median DFS and OS: 11.9 months and 16.5 months, respectively; p = 0.003). In the 25 patients with R0 resected tumors before treatment, only 6/113 (5.3%) of the recommendations of the panel surgeons recommended R0 resectability, compared with 17/48 (35.4%) after treatment (p < 0.001).

Conclusion

Tumor resectability of pancreatic cancer staged as unresectable at primary diagnosis should be reassessed after neoadjuvant treatment. The patient should undergo surgery if a resectability is reached, as this significantly improves their prognosis.

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Title: R0 resection following chemo (radio)therapy improves survival of primary inoperable pancreatic cancer patients. Interim results of the German randomized CONKO-007± trial
Authors: Prof. Dr. R. Fietkau
R. Grützmann
U. A. Wittel
R. S. Croner
L. Jacobasch
U. P. Neumann
A. Reinacher-Schick
D. Imhoff
S. Boeck
L. Keilholz
H. Oettle
W. M. Hohenberger
H. Golcher
W. O. Bechstein
W. Uhl
A. Pirkl
W. Adler
S. Semrau
S. Rutzner
M. Ghadimi
D. Lubgan
Publication date: 01-01-2021
Publisher: Springer Berlin Heidelberg
Keywords: Pancreatic Cancer
Pancreatic Cancer
Cytostatic Therapy
Published in: Strahlentherapie und Onkologie / Issue 1/2021
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-020-01680-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

R0 resection following chemo (radio)therapy improves survival of primary inoperable pancreatic cancer patients. Interim results of the German randomized CONKO-007± trial

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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