Journal of the Pancreas Open Access

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Neoadjuvant Chemo-Radiotherapy for Patients with Borderline Resectable Pancreatic Cancer: A Meta-Analytical Evaluation of Prospective Studies

Generoso Uomo, Virginia Festa, Angelo Andriulli, Francesco Perri, Salvatore Corrao, Maurizio Koch, Maria Rosaria Valvano, Nicola Andriulli

Context For patients with borderline resectable pancreatic cancer, the benefit of neoadjuvant therapy remains to be defined.Objective We did a systematic search of the literature on this topic. Methods Prospective studies where chemotherapy withor without radiotherapy was given before surgery to patients with borderline resectable cancer, were analyzed by a metaanalytical approach. Main outcome measures Primary outcome was surgical exploration and resection rates; tumorresponse, therapy-induced toxicity, and survival were secondary outcomes. Data were expressed as weighted pooledproportions with 95% confidence intervals (95% CI). Results Ten studies with 182 participants were included. Followingtreatment, 69% of patients (95% CI: 56-80%) were brought to surgery and 80% (95% CI: 66-90%) of surgically-exploredpatients were resected. Eighty-three percent (95% CI: 74-90%) of resected specimens were deemed R0 resections. Theweighted fractions of resected patients alive at 1 and 2 years were 61% (95% CI: 48-100%) and 44% (95% CI: 32-59%),respectively. At restaging following neoadjuvant therapy, weighted frequencies for complete/partial response were 16%(95% CI: 9-28%), 69% (95% CI: 60-76%) for stable disease, and 19% (95% CI: 13-25%) for progressive cancer. Treatmentrelated grade 3-4 toxicity was 32% (95% CI: 21-45%). Conclusion This meta-analysis shows that downstaging of the lesion following neoadjuvant therapies is uncommon for patients with borderline resectable pancreatic cancer. A clear benefit of this regimen could be to spare surgery to patients with progressive disease during the frame-time chemo-radiotherapy is being delivered.