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Preoperative Fluorouracil, Doxorubicin, and Streptozocin for the Treatment of Pancreatic Neuroendocrine Liver Metastases

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

While preoperative chemotherapy is frequently utilized before resection of non-neuroendocrine liver metastases, patients with resectable neuroendocrine liver metastases typically undergo surgery first. FAS is a cytotoxic chemotherapy regimen that is associated with substantial response rates in locally advanced and metastatic pancreatic neuroendocrine tumors.

Methods

All patients who underwent R0/R1 resection of pancreatic neuroendocrine liver metastases at a single institution between 1998 and 2015 were included. The outcomes of patients treated with preoperative FAS were compared with those of patients who were not.

Results

Of the 67 patients included, 27 (40.3%) received preoperative FAS, whereas 40 (59.7%) did not. Despite being associated with higher rates of synchronous disease, lymph node metastases, and larger tumor size, patients who received preoperative FAS had similar overall survival [overall survival (OS), 108.2 months (95% confidence interval (CI) 78.0–136.0) vs. 107.0 months (95% CI 78.0–136.0), p = 0.64] and recurrence-free survival [RFS, 25.1 months (95% CI 23.2–27.0) vs. 18.0 months (95% CI 13.8–22.2), p = 0.16] as patients who did not. Among patients who presented with synchronous liver metastases (n = 46), the median OS [97.3 months (95% CI 65.9–128.6) vs. 65.0 months (95% CI 28.1–101.9), p = 0.001] and RFS [24.8 months (95% CI 22.6–26.9) vs. 12.1 months (2.2–22.0), p = 0.003] were significantly greater among patients who received preoperative FAS compared with those who did not.

Conclusions

The use of FAS before liver resection is associated with improved OS compared with surgery alone among patients with advanced synchronous pancreatic neuroendocrine liver metastases.

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Acknowledgment

The authors recognize Ms. Ruth Haynes for administrative support in the preparation of this manuscript.

Disclosure

None of the authors have any conflicts of interest associated with this study.

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Author notes

  1. Jordan M. Cloyd and Kiyohiko Omichi have contributed equally to this work. Jean-Nicolas Vauthey and Arvind Dasari have contributed equally to this work.

Authors and Affiliations

  1. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jordan M. Cloyd MD, Kiyohiko Omichi MD, Takashi Mizuno MD, Yoshikuni Kawaguchi MD, Ching-Wei D. Tzeng MD, Claudius Conrad MD, Yun Shin Chun MD, Thomas A. Aloia MD, Matthew H. G. Katz MD, Jeffrey E. Lee MD & Jean-Nicolas Vauthey MD

  2. Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Daniel Halperin MD, James Yao MD & Arvind Dasari MD

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  1. Jordan M. Cloyd MD
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  3. Takashi Mizuno MD
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Corresponding authors

Correspondence to Jean-Nicolas Vauthey MD or Arvind Dasari MD.

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Cloyd, J.M., Omichi, K., Mizuno, T. et al. Preoperative Fluorouracil, Doxorubicin, and Streptozocin for the Treatment of Pancreatic Neuroendocrine Liver Metastases. Ann Surg Oncol 25, 1709–1715 (2018). https://doi.org/10.1245/s10434-018-6468-8

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