Xiang Feng*, Yuyao Liu*, Tiantian Zhao, Yawen Gao
Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, China.
* These authors contributed equally to this work.
Summary
Purpose: To explore the clinical efficacy and safety of modified FOLFIRINOX neoadjuvant chemotherapy (NACT) combined with surgery in the treatment of resectable pancreatic cancer.
Methods: A total of 88 patients with resectable pancreatic cancer were randomly divided into the NACT group (n=44, treated with preoperative modified FOLFIRINOX NACT combined with surgery) and the control group (n=44, treated with direct surgery). The tumor down-staging after NACT and efficacy and adverse reactions of NACT were analyzed, and the R0 resection rate, surgery conditions, postoperative complications and changes in the levels of serum tumor markers were compared.
Results: In the NACT group, the median cycle of NACT was 6.3 cycles (3-13 cycles), and the effective rate was 50% (22/44). T and N down-staging occurred in 12 cases (31.6%) and 14 cases (36.8%), respectively, and the total down-staging rate reached 36.8% after NACT. The R0 resection rate in the NACT group was obviously higher than in the control group. In the NACT group, the levels of serum carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) greatly declined after NACT, while they were greatly lower than in the control group at 1 d before surgery. At 7 d after surgery, the levels of serum CA19-9 and CEA markedly declined in the two groups, while they were markedly lower in the NACT group than in the control group. The median overall survival (OS) was 22.6 months and 19.2 months, and the median progression-free survival (PFS) was 13.4 months and 11.5 months, respectively, in the NACT group and the control group. Log-rank test revealed that both OS and PFS in the NACT group were remarkably better than in the control group.
Conclusion: Modified FOLFIRINOX NACT is safe and feasible in the treatment of resectable pancreatic cancer, which can effectively reduce the tumor stage, raise the R0 resection rate, and greatly improve the patient’s survival status and disease progression.
Key words: modified FOLFIRINOX regimen, neoadjuvant chemotherapy, pancreatic cancer, efficacy.
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