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01-01-2014 | 2013 SSAT Plenary Presentation

Treatment Sequencing for Resectable Pancreatic Cancer: Influence of Early Metastases and Surgical Complications on Multimodality Therapy Completion and Survival

Authors: Ching-Wei D. Tzeng, Hop S. Tran Cao, Jeffrey E. Lee, Peter W. T. Pisters, Gauri R. Varadhachary, Robert A. Wolff, James L. Abbruzzese, Christopher H. Crane, Douglas B. Evans, Huamin Wang, Daniel E. Abbott, Jean-Nicolas Vauthey, Thomas A. Aloia, Jason B. Fleming, Matthew H. G. Katz

Published in: Journal of Gastrointestinal Surgery | Issue 1/2014

Abstract

Barriers to multimodality therapy (MMT) completion among patients with resectable pancreatic adenocarcinoma include early cancer progression and postoperative major complications (PMC). We sought to evaluate the influence of these factors on MMT completion rates of patients treated with neoadjuvant therapy (NT) and surgery-first (SF) approaches. We evaluated all operable patients treated for clinically resectable pancreatic head adenocarcinoma at our institution from 2002 to 2007. Rates of MMT completion, 90-day PMC, and overall survival (OS) were evaluated. Ninety-five of 115 (83 %) NT and 29/50 (58 %) SF patients completed MMT. Patients who completed MMT lived longer than those who did not (36 vs. 11 months, p < 0.001). The most common reason that NT (11 %) and SF (26 %) patients failed to complete MMT was early disease progression. The rates of PMC among NT and SF patients were similar. Among SF patients, 69 % with no PMC completed MMT versus 29 % after PMC (p = 0.040). PMC were associated with decreased OS in SF patients but not in NT patients. The impact of early cancer progression and PMC upon completion of MMT is reduced by delivery of nonoperative therapies prior to pancreaticoduodenectomy. NT sequencing is a practical treatment strategy, particularly for patients at high biological or perioperative risk.

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Title: Treatment Sequencing for Resectable Pancreatic Cancer: Influence of Early Metastases and Surgical Complications on Multimodality Therapy Completion and Survival
Authors: Ching-Wei D. Tzeng
Hop S. Tran Cao
Jeffrey E. Lee
Peter W. T. Pisters
Gauri R. Varadhachary
Robert A. Wolff
James L. Abbruzzese
Christopher H. Crane
Douglas B. Evans
Huamin Wang
Daniel E. Abbott
Jean-Nicolas Vauthey
Thomas A. Aloia
Jason B. Fleming
Matthew H. G. Katz
Publication date: 01-01-2014
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 1/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-013-2412-1

At a glance: The STEP trials

Springer Medicine

Treatment Sequencing for Resectable Pancreatic Cancer: Influence of Early Metastases and Surgical Complications on Multimodality Therapy Completion and Survival

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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