Table 4.
Selected publications about the value of neoadjuvant or adjuvant therapy in relation to margin status
| Number of patients | R0 resection rate (%) | R0 definition | Neoadjuvant therapy | Median survival in months based on resection status | Adjuvant therapy | Notes | ||
| Resectable, no neoadjuvant treatment | R0 | R1/R2* | ||||||
| Fatima et al (Mayo)13 | 617 | 76 | 0 mm | 3.6% C 3.9% RT |
19 (en bloc) 18 (non-en bloc) |
15 (R1) 10 (R2) |
C or CRT in 80% | |
| Butturini et al (meta-analysis of four randomised trials: Norway, EORTC, Japan, ESPAC-1)4 | 875 | 68 | Variable | No | 15.9 | 14.1 | All/any | No difference in survival based on margin status |
| 53 | Variable | No | 15.9 | 14.7 | CRT | CRT only beneficial (NS) in R1 | ||
| 53 | Variable | No | 15.8 | 11.2 | No CRT | |||
| 109 | Variable | No | 20.8 | 15.0 | C | C beneficial (SS) in R0 | ||
| 114 | Variable | No | 13.4 | 13.2 | No C | |||
| Van den Broeck et al (Belgium)14 | 144 | 67 | <1 mm | No | 24 | 12.4 | CRT in 38, C in 31 | SS |
| Menon et al (Leeds)36 | 27 | 18 | 0 mm | No | >55 | 14 | Adjuvant NOS in 8/27 (30%) | Rigorous pathology protocol → higher R1 rate. All pts pT3 |
| Westgaard et al (Oslo)15 | 40 | 55 | <1 mm | No | 15 | 11 | No | |
| Herman et al (Johns Hopkins†)16 | 616 | 45 | <1 mm | No | 20 | 14 | CRT in 45% | Mean tumour size 3.2 cm |
| Oettle et al (CONKO-001)3 | 354 | 79 | 0 mm | No | 20 | No | Effect of margin status not significant; survival by margin status not given | |
| No | 23 | Gem | ||||||
| Richter et al (Germany)37 | 194 | 61 | ND | No | 12‡ | 24‡ | No | |
| Sperti et al (Italy)38 | 113 | 83 | ND | No | 14 | 7 | No | |
| Yeo et al (Johns Hopkins†)39 | 201 | 71 | ND | No | 18 | 10 | CRT in 56/201 (28%; MS 20 months for those pts) | |
| Willett et al (MGH)17 | 72 | 49 | ND | No | 19‡ | 11‡ | Any | |
| No | 20‡ | 12‡ | RT | |||||
| No | 18‡ | 9‡ | No RT | |||||
| Resectable, with neoadjuvant treatment | R0 | R1/2 | ||||||
| Golcher et al (Germany Phase II Trial)40 | 42 | 48 | ND | CRT | 25 | Phase II trial of upfront surgery versus neoadjuvant CRT. Results NS. | ||
| No | 19 | |||||||
| Breslin et al (MDACC)41 | 132 | 88 | ND | CRT; some IORT | 25 | 20 | No | ‘Potentially resectable’; margin status did not affect survival |
| Mixed stage, some neoadjuvant treatment | R0 | R1/2 | ||||||
| Raut et al (MDA)42 | 360 | 83 | 0 mm | Yes but % and details not recorded | 28 | 22 | Mix of resectable and BRPC; R0 did not predict survival on MVA | |
| Nishimura et al (Kyoto)43 | 157 | 55 | ND | Some received RT and/or IORT | 12 | 6 | Some CRT | Mixed stages |
| Borderline resectable or locally advanced | R0 | R1/R2 | ||||||
| Torgeson et al (NCDB)44 | 3077 | 88 | ND | C or CRT | 23 | 17 (R1) 12 (R2) |
Variable | |
| Ashman et al (Mayo Arizona)45 | 31 | 65 | ND | CRT and IORT | 23 | 17 | Some CT | BRPC (11) or LAPC (20) |
| Denost et al (Bordeaux)46 | 39 | 85 | ND | CRT | 33 | No | 97% T3/4 | |
| 72 | 75 | No | 24 | Some | 13% T3/4 | |||
*The majority of patients with positive resections in these studies had only microscopic disease.
†The Johns Hopkins report by Herman et al covers all pancreatic subsites, while the Johns Hopkins report by Yeo et al covers only head of pancreas.
‡Median survival not specifically reported; value estimated from printed survival curves.
BRPC, borderline resectable pancreas cancer; C, chemotherapy; CRT, chemoradiation therapy; Gen, gemcitabine; IORT, intraoperative radiation therapy; LAPC, locally advanced pancreas cancer; MDACC, MD Anderson Cancer Center; MGH, Massachusetts General Hospital; NCDB, National Cancer Database; ND, not defined; NS, not significant; pts, patients; SBRT, stereotactic body radiation therapy; SS, statistically significant.