R0 resection following chemo (radio)therapy improves survival of primary inoperable pancreatic cancer patients. Interim results of the German randomized CONKO-007± trial

Fietkau R, Grützmann R, Wittel UA, Croner RS, Jacobasch L, Neumann UP, Reinacher-Schick A, Imhoff D, Boeck S, Keilholz L, Oettle H, Hohenberger W, Golcher H, Bechstein WO, Uhl W, Pirkl A, Adler W, Semrau S, Rutzner S, Ghadimi M, Lubgan D (2020)

Publication Type: Journal article

Publication year: 2020

Journal

DOI: 10.1007/s00066-020-01680-2

Abstract

Purpose: Chemotherapy with or without radiotherapy is the standard in patients with initially nonmetastatic unresectable pancreatic cancer. Additional surgery is in discussion. The CONKO-007 multicenter randomized trial examines the value of radiotherapy. Our interim analysis showed a significant effect of surgery, which may be relevant to clinical practice. Methods: One hundred eighty patients received induction chemotherapy (gemcitabine or FOLFIRINOX). Patients without tumor progression were randomized to either chemotherapy alone or to concurrent chemoradiotherapy. At the end of therapy, a panel of five independent pancreatic surgeons judged the resectability of the tumor. Results: Following induction chemotherapy, 126/180 patients (70.0%) were randomized to further treatment. Following study treatment, 36/126 patients (28.5%) underwent surgery; (R0: 25/126 [19.8%]; R1/R2/Rx [n = 11/126; 6.1%]). Disease-free survival (DFS) and overall survival (OS) were significantly better for patients with R0 resected tumors (median DFS and OS: 16.6 months and 26.5 months, respectively) than for nonoperated patients (median DFS and OS: 11.9 months and 16.5 months, respectively; p = 0.003). In the 25 patients with R0 resected tumors before treatment, only 6/113 (5.3%) of the recommendations of the panel surgeons recommended R0 resectability, compared with 17/48 (35.4%) after treatment (p < 0.001). Conclusion: Tumor resectability of pancreatic cancer staged as unresectable at primary diagnosis should be reassessed after neoadjuvant treatment. The patient should undergo surgery if a resectability is reached, as this significantly improves their prognosis.

Authors with CRIS profile

Involved external institutions

Georg-August-Universität Göttingen Germany (DE) Klinikum Bayreuth Germany (DE) Universitätsklinikum Frankfurt am Main (KGU) Germany (DE) Ludwig-Maximilians-Universität (LMU) Germany (DE) Ruhr-Universität Bochum (RUB) Germany (DE) Universitätsklinikum Aachen (UKA) Germany (DE) Universitätsklinikum Magdeburg A.ö.R. Germany (DE) Albert-Ludwigs-Universität Freiburg Germany (DE)

How to cite

APA:

Fietkau, R., Grützmann, R., Wittel, U.A., Croner, R.S., Jacobasch, L., Neumann, U.P.,... Lubgan, D. (2020). R0 resection following chemo (radio)therapy improves survival of primary inoperable pancreatic cancer patients. Interim results of the German randomized CONKO-007± trial. Strahlentherapie und Onkologie. https://doi.org/10.1007/s00066-020-01680-2

MLA:

Fietkau, Rainer, et al. "R0 resection following chemo (radio)therapy improves survival of primary inoperable pancreatic cancer patients. Interim results of the German randomized CONKO-007± trial." Strahlentherapie und Onkologie (2020).

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