Title : Impact of duration of neoadjuvant therapy on outcomes of pancreatic cancer: A systematic review and meta-analysis
Abstract:
Objectives: To evaluate impact of duration of neoadjuvant treatment (NAT) on surgical resection rate, resection margin, response to treatment, and survival in patients with pancreatic ductal adenocarcinoma (PDAC).
Methods: All randomised controlled trials (RCTs) of NAT in patients with PDAC were included. Effect sizes were determined for surgical resection rate, R0 resection, radiological response to NAT and 1- to 5-years survival.
Results: Twenty-three RCTs (1880 patients) were included. NAT duration≤8 weeks was associated with significantly higher surgical resection rate compared with NAT duration >8 weeks. The difference remained significant when only resectable, borderline resectable, or mixed borderline resectable/locally advanced PDAC were considered. Moreover, when only NAT with chemotherapy considered, resection rate remained significant in favour of NAT duration≤8. No significant difference was found in R0 resection rate, partial response, stable disease, or disease progression between two groups. Intention-to-treat respected 1-, 3-, 5-years survival were comparable.
Conclusions: NAT duration >8 weeks is associated with a reduced surgical resection rate and no apparent improvement in negative resection margin in patients with PDAC, particularly borderline resectable cases. However, it has comparable survival to NAT duration ≤8 weeks. Considering the available evidence, early surgical resection should be considered after short-course NAT for most patients.
