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Intraoperative Radiation Mitigates the Effect of Microscopically Positive Tumor Margins on Survival Among Pancreatic Adenocarcinoma Patients Treated with Neoadjuvant FOLFIRINOX and Chemoradiation

  • Pancreatic Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Microscopically positive margins (R1) negatively impact survival in pancreatic ductal adenocarcinoma (PDAC). For patients with close/positive margins, intraoperative radiotherapy (IORT) can improve local control. The prognostic impact of an R1 resection in patients who receive total neoadjuvant therapy (TNT; FOLFIRINOX with chemoradiation) and IORT is unknown.

Methods

Clinicopathologic data were retrospectively collected for borderline/locally advanced (BR/LA) PDAC patients who received TNT and underwent resection between 2011 and 2019. Disease-free (DFS) and overall survival (OS) measured from time of diagnosis were compared between groups.

Results

Two hundred one patients received TNT and were resected, with a median DFS and OS of 24 months and 47 months, respectively. Eighty-eight patients (44%) received IORT; of these, 69 (78%) underwent an R0 and 19 (22%) an R1 resection. There was no significant difference in clinicopathologic factors between the IORT and no-IORT groups, except for resectability status (LA: IORT 69%, no-IORT 53%, p = 0.021) and surgeons’ concern for a positive/close margin. R1 resection was associated with worse DFS and OS in the no-IORT population. However, among patients who received IORT, there was no difference in DFS (R0: 29 months, IQR 14–47 vs R1: 20 months, IQR 15–28; p = 0.114) or OS (R0: 48 months, IQR 25-not reached vs R1: 37 months, IQR 30–47; p = 0.307) between patients who underwent R0 vs R1 resection. In multivariate analysis, within the IORT group, R1 resection was not associated with DFS or OS.

Conclusion

IORT may mitigate the adverse effect of an R1 resection on DFS and OS in BR/LA PDAC patients receiving TNT.

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Author notes

  1. Yurie Sekigami and Theodoros Michelakos have contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Wang 460, 15 Parkman Street, Boston, MA, 02114, USA

    Yurie Sekigami MD, Theodoros Michelakos MD, Carlos Fernandez-del Castillo MD, Filippos Kontos MD, Motaz Qadan MD, PhD, Jon Harrison MD, Onofrio Catalano MD, Keith D. Lillemoe MD & Cristina R. Ferrone MD

  2. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Jennifer Y. Wo MD, Onofrio Catalano MD & Theodore S. Hong MD

  3. Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Vikram Deshpande MBBS & Onofrio Catalano MD

  4. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Onofrio Catalano MD

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  1. Yurie Sekigami MD
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Correspondence to Cristina R. Ferrone MD.

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Sekigami, Y., Michelakos, T., Fernandez-del Castillo, C. et al. Intraoperative Radiation Mitigates the Effect of Microscopically Positive Tumor Margins on Survival Among Pancreatic Adenocarcinoma Patients Treated with Neoadjuvant FOLFIRINOX and Chemoradiation. Ann Surg Oncol 28, 4592–4601 (2021). https://doi.org/10.1245/s10434-020-09444-z

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  • DOI: https://doi.org/10.1245/s10434-020-09444-z

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