Z Gastroenterol 2019; 57(09): e317-e318
DOI: 10.1055/s-0039-1695452
Gastroenterologische Onkologie
Pankreaskarzinom: Medikamentöse Therapie: Freitag, 04. Oktober 2019, 16:45 – 17:57, Studio Terrasse 2.2 A
Georg Thieme Verlag KG Stuttgart · New York

R0-resection following chemotherapy or chemoradiation improves survival of primary inoperable pancreatic cancer patients. Interim results of the CONKO-007 prospective randomized multicenter trial

, , CONKO-007 study group
M Brunner
1   Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
,
U Wittel
2   Universitätsklinikum Freiburg, Freiburg, Deutschland
,
R Croner
3   Universitätsklinikum Magdeburg, Magdeburg, Deutschland
,
M Ghadimi
4   Universitätsklinikum Göttingen, Göttingen, Deutschland
,
L Jacobasch
5   Private Practice of Hematology/Oncology, Dresden, Deutschland
,
U Neumann
6   Universitätsklinikum Aachen, Aachen, Deutschland
,
A Reinacher-Schick
7   Universitätsklinikum Bochum, Bochum, Deutschland
,
D Imhoff
8   Universitätsklinikum Frankfurt, Frankfurt, Deutschland
,
S Böck
9   Klinik Großhadern, Universitätsklinikum München, München, Deutschland
,
L Keilholz
10   Clinical Center Bayreuth, Bayreuth, Deutschland
,
H Oettle
11   Outpatient Department Hemtalogy/Oncology Friedrichshafen, Friedrichshafen, Deutschland
,
W Hohenberger
1   Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
,
WO Bechstein
8   Universitätsklinikum Frankfurt, Frankfurt, Deutschland
,
W Uhl
7   Universitätsklinikum Bochum, Bochum, Deutschland
,
A Pirkl
1   Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
,
W Adler
1   Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
,
S Semrau
1   Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
,
D Lubgan
1   Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
,
R Fietkau
1   Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
,
R Grützmann
1   Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
13 August 2019 (online)

 

Introduction:

It remains unclear whether patients with initially unresectable pancreatic cancer can achieve resectable status and, if so, whether surgery provides them any additional benefit.

Methods:

CONKO-007 is a multicenter, phase III randomized clinical trial which examines the effectiveness of chemoradiotherapy compared to chemotherapy alone after induction chemotherapy in patients with non-metastatic, initially locally advanced unresectable pancreatic cancer. The present analysis was based on data from the first 180 patients recruited from 2013 to 2015.

Results:

Induction chemotherapy consisted of gemcitabine in 43 cases and of FOLFIRINOX in 137 cases. After induction chemotherapy, 126/180 patients (70.0%) were randomized to further treatment. The main reasons for non-randomization were distant metastasis (29.6%), patient request (24.1%), local progression (13.0%) and side effects (13.0%). After completion of study treatment 36 patients (20.0%) underwent surgery and 87 (48.3%) received no surgical treatment. R0 resection was achieved in 25 cases (13.9%) versus exploration or R1/R2/Rx resection in 11 cases (6.1%). Five patients (13.9%) developed postoperative major complications: bleeding (n = 1), pancreatic fistula (n = 1), wound healing disturbance (n = 1), ileus (n = 1), and insufficiency of gastric anastomosis (n = 1). Mortality was 5.5%. Overall survival was significantly better in the R0 resection group (26.5 months) than in the non-operated patients (16.5 months) or patients in the exploration or R1/R2/Rx resection group (16.9 months) (p = 0.003).

Conclusion:

Even if pancreatic cancer is staged as locally advanced unresectable at primary diagnosis, resectability should be reassessed after neoadjuvant treatment. Patients with a good probability of R0 resection should undergo surgery as this significantly improves their prognosis.