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Neoadjuvant treatment in pancreatic cancer: Evidence-based medicine? A systematic review and meta-analysis.

Abstract Neoadjuvant treatment in non-metastatic pancreatic cancer (PaC) has the theoretical advantages of downstaging the tumor, sterilizing any present systemic undetectable disease, selecting patients for surgery and administering therapy to each patient. The aim of this systematic review is to analyze the state of the art on neoadjuvant protocols for non-metastatic PaC. A literature search over the last 10 years was conducted, and papers had to be focused on resectable, borderline resectable (BLR) or locally advanced (LA) histo- or cytologically proven PaC; to be prospective studies or prospectively collected databases; to report percentage of protocol achievement and survival data at least in an intention-to-treat (ITT) analysis. Twelve studies were eligible for systematic review. Studies included a total of 624 patients: 248 resectable, 268 BLR, 71 LA and 37 non-specified. All studies were included for meta-analysis. ITT overall survival (OS) was 16.7 months (95% CI 15.16-18.26 months); for resected patients OS was 22.78 months (95% CI 20.42-25.16), and for eventually non-resected patients it was 9.89 months (95% CI 8.84-10.96). Neoadjuvant approaches for resectable, BLR and LA PaC are spreading. Outcomes tend to be better outside an RCT context, but strong evidences are lacking. Actually such treatments should be performed only in a randomized clinical trial setting.
PMID
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Authors

Mayor MeshTerms
Keywords

Borderline

Neoadjuvant therapy

Pancreatic cancer

Resectable

Surgery

Survival

Journal Title medical oncology (northwood, london, england)
Publication Year Start




PMID- 28391577
OWN - NLM
STAT- MEDLINE
DA  - 20170409
DCOM- 20170419
LR  - 20170419
IS  - 1559-131X (Electronic)
IS  - 1357-0560 (Linking)
VI  - 34
IP  - 5
DP  - 2017 May
TI  - Neoadjuvant treatment in pancreatic cancer: Evidence-based medicine? A systematic
      review and meta-analysis.
PG  - 85
LID - 10.1007/s12032-017-0951-0 [doi]
AB  - Neoadjuvant treatment in non-metastatic pancreatic cancer (PaC) has the
      theoretical advantages of downstaging the tumor, sterilizing any present systemic
      undetectable disease, selecting patients for surgery and administering therapy to
      each patient. The aim of this systematic review is to analyze the state of the
      art on neoadjuvant protocols for non-metastatic PaC. A literature search over the
      last 10 years was conducted, and papers had to be focused on resectable,
      borderline resectable (BLR) or locally advanced (LA) histo- or cytologically
      proven PaC; to be prospective studies or prospectively collected databases; to
      report percentage of protocol achievement and survival data at least in an
      intention-to-treat (ITT) analysis. Twelve studies were eligible for systematic
      review. Studies included a total of 624 patients: 248 resectable, 268 BLR, 71 LA 
      and 37 non-specified. All studies were included for meta-analysis. ITT overall
      survival (OS) was 16.7 months (95% CI 15.16-18.26 months); for resected patients 
      OS was 22.78 months (95% CI 20.42-25.16), and for eventually non-resected
      patients it was 9.89 months (95% CI 8.84-10.96). Neoadjuvant approaches for
      resectable, BLR and LA PaC are spreading. Outcomes tend to be better outside an
      RCT context, but strong evidences are lacking. Actually such treatments should be
      performed only in a randomized clinical trial setting.
FAU - D'Angelo, Francesco
AU  - D'Angelo F
AD  - Division of General Surgery, Department of Medical and Surgical Sciences and
      Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea
      Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
FAU - Antolino, Laura
AU  - Antolino L
AD  - Division of General Surgery, Department of Medical and Surgical Sciences and
      Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea
      Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
      [email protected]
FAU - Farcomeni, Alessio
AU  - Farcomeni A
AD  - Department of Public Health and Infectious Diseases, Sapienza University, Rome,
      Italy.
FAU - Sirimarco, Dario
AU  - Sirimarco D
AD  - Division of General Surgery, Department of Medical and Surgical Sciences and
      Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea
      Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
FAU - Kazemi Nava, Andrea
AU  - Kazemi Nava A
AD  - Division of General Surgery, Department of Medical and Surgical Sciences and
      Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea
      Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
FAU - De Siena, Martina
AU  - De Siena M
AD  - Division of General Surgery, Department of Medical and Surgical Sciences and
      Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea
      Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
FAU - Petrucciani, Niccolo
AU  - Petrucciani N
AD  - Division of General Surgery, Department of Medical and Surgical Sciences and
      Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea
      Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
AD  - Digestive Surgery and Liver Transplantation Unit, Nice University Hospital, Nice,
      France.
FAU - Nigri, Giuseppe
AU  - Nigri G
AD  - Division of General Surgery, Department of Medical and Surgical Sciences and
      Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea
      Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
FAU - Valabrega, Stefano
AU  - Valabrega S
AD  - Division of General Surgery, Department of Medical and Surgical Sciences and
      Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea
      Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
FAU - Aurello, Paolo
AU  - Aurello P
AD  - Division of General Surgery, Department of Medical and Surgical Sciences and
      Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea
      Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
FAU - Ramacciato, Giovanni
AU  - Ramacciato G
AD  - Division of General Surgery, Department of Medical and Surgical Sciences and
      Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea
      Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20170408
PL  - United States
TA  - Med Oncol
JT  - Medical oncology (Northwood, London, England)
JID - 9435512
SB  - IM
MH  - Evidence-Based Medicine
MH  - Humans
MH  - Neoadjuvant Therapy
MH  - Pancreatectomy/methods
MH  - Pancreatic Neoplasms/surgery/*therapy
OTO - NOTNLM
OT  - *Borderline
OT  - *Neoadjuvant therapy
OT  - *Pancreatic cancer
OT  - *Resectable
OT  - *Surgery
OT  - *Survival
EDAT- 2017/04/10 06:00
MHDA- 2017/04/10 06:00
CRDT- 2017/04/10 06:00
PHST- 2017/03/25 [received]
PHST- 2017/04/04 [accepted]
AID - 10.1007/s12032-017-0951-0 [doi]
AID - 10.1007/s12032-017-0951-0 [pii]
PST - ppublish
SO  - Med Oncol. 2017 May;34(5):85. doi: 10.1007/s12032-017-0951-0. Epub 2017 Apr 8.

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