TY - JOUR
T1 - Role of Fluorouracil, Doxorubicin, and Streptozocin Therapy in the Preoperative Treatment of Localized Pancreatic Neuroendocrine Tumors
AU - Prakash, Laura REKA
AU - Bhosale, Priya
AU - Cloyd, Jordan
AU - Kim, Michael
AU - Parker, Nathan
AU - Yao, James
AU - Dasari, Arvind
AU - Halperin, Daniel
AU - Aloia, Thomas
AU - Lee, Jeffrey E.
AU - Vauthey, Jean Nicolas
AU - Fleming, Jason B
AU - Katz, Matthew H.G.
N1 - Publisher Copyright:
© 2016, The Society for Surgery of the Alimentary Tract.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Introduction: 5-Fluorouracil, doxorubicin, and streptozocin (FAS) leads to a 39 % response rate in advanced pancreatic neuroendocrine tumors (pNETs). We sought to validate our hypothesis that preoperative FAS may facilitate resection of locoregionally advanced pNETs by reducing the anatomic extent of the primary tumor. Patients: All patients who received FAS between 2000 and 2012 as initial therapy for a localized pNET were reviewed. Tumor size and vascular relationships were compared on pretreatment and posttreatment imaging studies to quantify treatment response. Results: Twenty-nine patients received a median 4 cycles of FAS (range 2–15). Rates of RECIST progressive disease (PD), stable disease (SD), and partial response (PR) were 3, 90, and 7 %, respectively. An interface was observed between the tumor and a major mesenteric artery and/or vein in 19 (66 %) and 24 (83 %) patients, respectively; after therapy with FAS, 17 (59 %) and 22 (76 %) had persistent interface with artery and/or vein. Fourteen (48 %) patients underwent pancreatectomy, 7 (50 %) required vascular management, and 9 (64 %) operations were R0. The median overall survival of unresected and resected patients was 41 months (95 % CI, 16–66) and 112 months (95 % CI, 104–120) (P = 0.04). Conclusions: Although patients receiving FAS for locoregionally advanced pNETs are unlikely to progress during systemic therapy, significant “downstaging” appears uncommon.
AB - Introduction: 5-Fluorouracil, doxorubicin, and streptozocin (FAS) leads to a 39 % response rate in advanced pancreatic neuroendocrine tumors (pNETs). We sought to validate our hypothesis that preoperative FAS may facilitate resection of locoregionally advanced pNETs by reducing the anatomic extent of the primary tumor. Patients: All patients who received FAS between 2000 and 2012 as initial therapy for a localized pNET were reviewed. Tumor size and vascular relationships were compared on pretreatment and posttreatment imaging studies to quantify treatment response. Results: Twenty-nine patients received a median 4 cycles of FAS (range 2–15). Rates of RECIST progressive disease (PD), stable disease (SD), and partial response (PR) were 3, 90, and 7 %, respectively. An interface was observed between the tumor and a major mesenteric artery and/or vein in 19 (66 %) and 24 (83 %) patients, respectively; after therapy with FAS, 17 (59 %) and 22 (76 %) had persistent interface with artery and/or vein. Fourteen (48 %) patients underwent pancreatectomy, 7 (50 %) required vascular management, and 9 (64 %) operations were R0. The median overall survival of unresected and resected patients was 41 months (95 % CI, 16–66) and 112 months (95 % CI, 104–120) (P = 0.04). Conclusions: Although patients receiving FAS for locoregionally advanced pNETs are unlikely to progress during systemic therapy, significant “downstaging” appears uncommon.
KW - Downsizing
KW - FAS
KW - Fluorouracil, doxorubicin, and streptozocin
KW - Pancreas neuroendocrine tumors
KW - Pancreatectomy
KW - Response rate
KW - Tumor vessel interface
KW - pNETs, preoperative therapy
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U2 - 10.1007/s11605-016-3270-4
DO - 10.1007/s11605-016-3270-4
M3 - Article
C2 - 27634306
AN - SCOPUS:84988354729
SN - 1091-255X
VL - 21
SP - 155
EP - 163
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 1
ER -