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Walma MS, Brada LJ, Patuleia SIS, Blomjous JG, Bollen TL, Bosscha K, Bruijnen RC, Busch OR, Creemers GJ, Daams F, van Dam R, Festen S, Jan de Groot D, Willem de Groot J, Mohammad NH, Hermans JJ, de Hingh IH, Kerver ED, van Leeuwen MS, van der Leij C, Liem MS, van Lienden KP, Los M, de Meijer VE, Meijerink MR, Mekenkamp LJ, Nederend J, Nio CY, Patijn GA, Polée MB, Pruijt JF, Renken NS, Rombouts SJ, Schouten TJ, Stommel MWJ, Verweij ME, de Vos-Geelen J, de Vries JJJ, Vulink A, Wessels FJ, Wilmink JW, van Santvoort HC, Besselink MG, Molenaar IQ. Treatment strategies and clinical outcomes in consecutive patients with locally advanced pancreatic cancer: A multicenter prospective cohort. Eur J Surg Oncol 2020; 47:699-707. [PMID: 33280952 DOI: 10.1016/j.ejso.2020.11.137] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/10/2020] [Accepted: 11/21/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Since current studies on locally advanced pancreatic cancer (LAPC) mainly report from single, high-volume centers, it is unclear if outcomes can be translated to daily clinical practice. This study provides treatment strategies and clinical outcomes within a multicenter cohort of unselected patients with LAPC. MATERIALS AND METHODS Consecutive patients with LAPC according to Dutch Pancreatic Cancer Group criteria, were prospectively included in 14 centers from April 2015 until December 2017. A centralized expert panel reviewed response according to RECIST v1.1 and potential surgical resectability. Primary outcome was median overall survival (mOS), stratified for primary treatment strategy. RESULTS Overall, 422 patients were included, of whom 77% (n = 326) received chemotherapy. The majority started with FOLFIRINOX (77%, 252/326) with a median of six cycles (IQR 4-10). Gemcitabine monotherapy was given to 13% (41/326) of patients and nab-paclitaxel/gemcitabine to 10% (33/326), with a median of two (IQR 3-5) and three (IQR 3-5) cycles respectively. The mOS of the entire cohort was 10 months (95%CI 9-11). In patients treated with FOLFIRINOX, gemcitabine monotherapy, or nab-paclitaxel/gemcitabine, mOS was 14 (95%CI 13-15), 9 (95%CI 8-10), and 9 months (95%CI 8-10), respectively. A resection was performed in 13% (32/252) of patients after FOLFIRINOX, resulting in a mOS of 23 months (95%CI 12-34). CONCLUSION This multicenter unselected cohort of patients with LAPC resulted in a 14 month mOS and a 13% resection rate after FOLFIRINOX. These data put previous results in perspective, enable us to inform patients with more accurate survival numbers and will support decision-making in clinical practice.
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Affiliation(s)
- Marieke S Walma
- Dept. of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands; Dept. of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lilly J Brada
- Dept. of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands; Dept. of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Susana I S Patuleia
- Dept. of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | | | - Thomas L Bollen
- Dept. of Radiology, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - Koop Bosscha
- Dept. of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Rutger C Bruijnen
- Dept. of Radiology, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - Olivier R Busch
- Dept. of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Geert-Jan Creemers
- Dept. of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Freek Daams
- Dept. of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ronald van Dam
- Dept. of Surgery, Maastricht UMC+, Maastricht, the Netherlands
| | | | - Derk Jan de Groot
- Dept. of Medical Oncology, UMC Groningen, Groningen, the Netherlands
| | | | - Nadia Haj Mohammad
- Dept. of Medical Oncology, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - John J Hermans
- Dept. of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Emile D Kerver
- Dept. of Medical Oncology, OLVG, Amsterdam, the Netherlands
| | - Maarten S van Leeuwen
- Dept. of Radiology, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | | | - Mike S Liem
- Dept. of Surgery, Medical Spectrum Twente, Enschede, the Netherlands
| | - Krijn P van Lienden
- Dept. of Radiology Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amstrdam, the Netherlands
| | - Maartje Los
- Dept. of Medical Oncology, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | | | - Martijn R Meijerink
- Dept. of Radiology Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amstrdam, the Netherlands
| | - Leonie J Mekenkamp
- Dept. of Medical Oncology, Medical Spectrum Twente, Enschede, the Netherlands
| | - Joost Nederend
- Dept. of Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - C Yung Nio
- Dept. of Radiology Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amstrdam, the Netherlands
| | - Gijs A Patijn
- Dept. of Surgery, Isala Clinics, Zwolle, the Netherlands
| | - Marco B Polée
- Dept. of Medical Oncology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Johannes F Pruijt
- Dept. of Medical Oncology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Nomdo S Renken
- Dept. of Radiology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Steffi J Rombouts
- Dept. of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands; Dept. of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Thijs J Schouten
- Dept. of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - Martijn W J Stommel
- Dept. of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maaike E Verweij
- Dept. of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - Judith de Vos-Geelen
- Dept. of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht UMC+, Maastricht, the Netherlands
| | - Jan J J de Vries
- Dept. of Radiology Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amstrdam, the Netherlands
| | - Annelie Vulink
- Dept. of Medical Oncology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Frank J Wessels
- Dept. of Radiology, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - Johanna W Wilmink
- Dept. of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam; the Netherlands
| | - Hjalmar C van Santvoort
- Dept. of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - Marc G Besselink
- Dept. of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - I Quintus Molenaar
- Dept. of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
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