Systematic review on the treatment of isolated local recurrence of pancreatic cancer after surgery; re-resection, chemoradiotherapy and SBRT

Vincent P Groot; Hjalmar C van Santvoort; Steffi J E Rombouts; Jeroen Hagendoorn; Inne H M Borel Rinkes; Marco van Vulpen; Joseph M Herman; Christopher L Wolfgang; Marc G Besselink; I Quintus Molenaar

doi:10.1016/j.hpb.2016.11.001

Systematic review on the treatment of isolated local recurrence of pancreatic cancer after surgery; re-resection, chemoradiotherapy and SBRT

HPB (Oxford). 2017 Feb;19(2):83-92. doi: 10.1016/j.hpb.2016.11.001. Epub 2017 Jan 3.

Affiliations

¹ Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands; Dept. of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Dept. of Surgery, St. Antonius Hospital Nieuwegein, The Netherlands; Dept. of Surgery, Academic Medical Center Amsterdam, The Netherlands.
³ Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands.
⁴ Dept. of Radiation Oncology, University Medical Center Utrecht Cancer Center, The Netherlands.
⁵ Dept. of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Dept. of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁷ Dept. of Surgery, Academic Medical Center Amsterdam, The Netherlands.
⁸ Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands. Electronic address: i.q.molenaar@umcutrecht.nl.

PMID: 28065427
DOI: 10.1016/j.hpb.2016.11.001

Abstract

Background: The majority of patients who have undergone a pancreatic resection for pancreatic cancer develop disease recurrence within two years. In around 30% of these patients, isolated local recurrence (ILR) is found. The aim of this study was to systematically review treatment options for this subgroup of patients.

Methods: A systematic search was performed in PubMed, Embase and the Cochrane Library. Studies reporting on the treatment of ILR after initial curative-intent resection of primary pancreatic cancer were included. Primary endpoints were morbidity, mortality and survival after ILR treatment.

Results: After screening 1152 studies, 18 studies reporting on 313 patients undergoing treatment for ILR were included. Treatment options for ILR included surgical re-resection (8 studies, 100 patients), chemoradiotherapy (7 studies, 153 patients) and stereotactic body radiation therapy (SBRT) (4 studies, 60 patients). Morbidity and mortality were reported for re-resection (29% and 1%, respectively), chemoradiotherapy (54% and 0%) and SBRT (3% and 1%). Most patients had a prolonged disease-free interval before recurrence. Median survival after treatment of ILR of up to 32, 19 and 16 months was reported for re-resection, chemoradiotherapy and SBRT, respectively.

Conclusion: In selected patients, treatment of ILR following pancreatic resection for pancreatic cancer seems safe, feasible and associated with relatively good survival.

Publication types

Review
Systematic Review

MeSH terms

Chemoradiotherapy* / adverse effects
Chemoradiotherapy* / mortality
Disease-Free Survival
Humans
Neoplasm Recurrence, Local / mortality
Neoplasm Recurrence, Local / pathology
Neoplasm Recurrence, Local / therapy*
Pancreatectomy* / adverse effects
Pancreatectomy* / mortality
Pancreatic Neoplasms / mortality
Pancreatic Neoplasms / pathology
Pancreatic Neoplasms / therapy*
Radiosurgery* / adverse effects
Radiosurgery* / mortality
Reoperation
Risk Factors
Time Factors
Tomography, X-Ray Computed
Treatment Outcome