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Locally Advanced Pancreatic Cancer: Neoadjuvant Therapy With Folfirinox Results In Resectability In 2/3 Of The Patients
Thilo Hackert*, Milena Sachsenmaier*, Ulf Hinz*, Schneider Lutz*, Christoph Michalski*, Christoph Springfeld*, Oliver Strobel*, Dirk Jäger*, Alexis Ulrich*, Markus W Buechler
University Hospital Heidelberg, Heidelberg, Germany

Objective. For patients with locally advanced and unresectable pancreatic cancer, neodadjuvant treatment and consecutive surgical exploration has been studied during the last decade. To date a wide variety of neoadjuvant therapies including chemotherapy and combinations with radiation are used. Aim of the study was the evaluation of neoadjuvant therapy with a focus on FOLFIRINOX.
Methods: In a prospective study, all consecutive patients undergoing surgery for pancreatic cancer after neoadjuvant treatment were analysed including clinico-pathological characteristics, secondary resections rates and outcome. Patients receiving FOLFIRINOX were compared to other treatment regimens.
Results: Between 12/2001 and 06/2015, 582 patients with locally advanced pancreatic cancer received neoadjuvant treatment and were scheduled for resection after re-staging. A successful resection was achieved in 291 patients (50%). Resection rates following FOLFIRINOX were 63.3% (74/117 pat.) and 46.7% (217/465 pat.) after other treatments. Median overall survival was 16.5 m after resection vs. 8.9 m after exploration alone (p<0.0001). Patients resected after FOLFIRINOX had a better long-term outcome than those receiving other regimens (median survival of 24.7 m vs. 16.5 m and 42.5% vs. 23.0% 3-year survival (p=0.628).
Conclusions. FOLFIRINOX is a valuable treatment option in the neoadjuvant therapy of pancreatic cancer. From the present data, which represent the largest available study population to date, FOLFIRINOX seems to be the most effective protocol resulting in a significantly higher secondary resection rate than other treatments and a better long-term survival. It should be considered in all patients fit for this regimen and consecutive surgical exploration.


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