Society of University SurgeonsNeoadjuvant therapy in pancreatic adenocarcinoma: A meta-analysis of phase II trials
Section snippets
Study design and data collection
Studies considered for our meta-analysis included prospective phase II trials investigating the effects of neoadjuvant chemotherapy and/or neoadjuvant radiation on patients with locally advanced and unresectable pancreatic cancer. Retrospective studies, phase I trials, cohort studies, case series, and case reports were excluded.
Studies were identified using MEDLINE, and the Cochrane Central Register of Controlled Trials from 1960 to July 2010. The following key words and phrases were used to
Results
Out of 397 initially retrieved studies, 14 phase II trials from 1993 to 2010 were chosen to include in this meta-analysis (Supplemental Table). The 14 phase II trials included 536 patients. The University of Texas M.D. Anderson Cancer Center (Houston, TX) and the Fox Chase Cancer Center (Philadelphia, PA) each published 2 studies. All other studies were published by independent groups.
All 14 trials were prospective studies. Twelve (86%) were single-arm studies, and 2 trials randomized patients
Discussion
The aim of this meta-analysis and review of the literature was to investigate the potential role for neoadjuvant treatment in patients with pancreatic adenocarcinoma. Neoadjuvant therapy has been shown to have a substantial impact in several GI malignancies and has many theoretic advantages over adjuvant treatment in patients with pancreatic adenocarcinoma. Preoperative treatment has been proposed to have greater benefits on well-oxygenated, nondevascularized tissue, with improved delivery of
Conclusion
The data compiled from this meta-analysis highlight the importance of preoperative staging. Despite the limitations of this study, the data suggest that patients with borderline or unresectable disease may achieve the most benefit from neoadjuvant treatment. Like other GI malignancies, treating patients with borderline resectable pancreatic cancer before operative intervention may allow for resection in a substantial number of these patients, and provides a period of time to select those
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Supported by the National Institutes of Health (CA016042 and P01AT003960).