S. Willis5, A. Ardeljan1,3, D. Maurente1,5, A. Johns1, H. Abdul1, M. Bustos1,3, S. Susie2, M. Ghali1, O. M. Rashid1 1Holy Cross Hospital,Michael and Dianne Bienes Comprehensive Cancer Center,Fort Lauderdale, FL, USA 2Massachusetts General Hospital,Cancer Center,Boston, MA, USA 3University Of Miami Miller School Of Medicine,Miami, FL, USA 4Charles E. Schmidt College Of Medicine At Florida Atlantic University,Boca Raton, FL, USA 5Nova Southeastern University College Of Osteopathic Medicine,Fort Lauderdale, FL, USA
Introduction: There is no consensus combination therapy clinical pathway (CP) based on randomized prospective studies for the management of borderline resectable pancreatic adenocarcinoma (BPA) and locally advanced pancreatic cancer (LAPC). Therefore, BPA and LAPC CP's vary by institution. We recently reviewed outcomes of different CP‘s and now seek to compare results to further evaluate optimal therapy.
Methods: We performed a literature review of all BPA and LAPC CP reports, BPA diagnostic criteria, pancreatectomy rate, margin status, pathologic response (grade IIa-IV) rate (PR), disease free (DFS), disease specific (DSS), and overall survival (OS) were reviewed and compared. Standard statistical methods were used for statistical comparison.
Results: There were 9 studies which met inclusion criteria. 2,745 entered 9 CP’s. 1,750 met NCCN/AHPBA diagnostic criteria, 144 MDACC and 257 Surgeon Judgement. Of these patients, 21.2% – 93% completed neoadjuvant therapy. The neoadjuvant regimens included: 5-Fluorouracil, Paclitaxel, Cabecitabine, Gemcitabine, Cisplain, Folfirinox, XRT, EBT, IORT, GT, GTX, SBRT, and/or CHXRT. The resection rate was 38%-90%, R0 resection rate was 35-97%, pathological response for GII, GIII, GIV was 14.8%-57%, 14%-82% and 0%-17%, respectively. Median follow up was 11-27 months. Median overall survival after resection was from 8-40 months, median disease free survival was 17-24 months. Without resection median overall survival was 11-24 months, and 8-15 months after metastasis.
Conclusion: Comparative analysis demonstrates that many BPA and LAPC patients benefit from the reported CP’s. However, the differences in reported resection and pathologic response to treatment rates between institutional CP’s warrant further investigation to determine optimal therapy.