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Title: Multi-institutional Pooled Analysis on Adjuvant Chemoradiation in Pancreatic Cancer

Purpose: To determine the impact of chemoradiation therapy (CRT) on overall survival (OS) after resection of pancreatic adenocarcinoma. Methods and Materials: A multicenter retrospective review of 955 consecutive patients who underwent complete resection with macroscopically negative margins (R0-1) for invasive carcinoma (T1-4; N0-1; M0) of the pancreas was performed. Exclusion criteria included metastatic or unresectable disease at surgery, macroscopic residual disease (R2), treatment with intraoperative radiation therapy (IORT), and a histological diagnosis of no ductal carcinoma, or postoperative death (within 60 days of surgery). In all, 623 patients received postoperative radiation therapy (RT), 575 patients received concurrent chemotherapy (CT), and 462 patients received adjuvant CT. Results: Median follow-up was 21.0 months. Median OS after adjuvant CRT was 39.9 versus 24.8 months after no adjuvant CRT (P<.001) and 27.8 months after CT alone (P<.001). Five-year OS was 41.2% versus 24.8% with and without postoperative CRT, respectively. The positive impact of CRT was confirmed by multivariate analysis (hazard ratio [HR] = 0.72; confidence interval [CI], 0.60-0.87; P=.001). Adverse prognostic factors identified by multivariate analysis included the following: R1 resection (HR = 1.17; CI = 1.07-1.28; P<.001), higher pT stage (HR = 1.23; CI = 1.11-1.37; P<.001), positive lymph nodes (HR = 1.27; CI = 1.15-1.41; P<.001), and tumor diameter >20 mm (HR = 1.14; CI = 1.05-1.23;more » P=.002). Multivariate analysis also showed a better prognosis in patients treated in centers with >10 pancreatic resections per year (HR = 0.87; CI = 0.78-0.97; P=.014) Conclusion: This study represents the largest comparative study on adjuvant therapy in patients after resection of carcinoma of the pancreas. Overall survival was better in patients who received adjuvant CRT.« less
Authors:
 [1] ;  [2] ;  [3] ;  [4] ;  [1] ;  [5] ;  [6] ;  [7] ;  [8] ;  [9] ;  [10] ;  [11] ;  [12] ;  [13] ;  [12] ;  [14] ;
  1. Department of Radiotherapy, Università Cattolica S. Cuore, Rome (Italy)
  2. (Italy)
  3. Department of Surgery, University of Verona, Verona (Italy)
  4. Department of Radiation Oncology (MAASTRO), GROW, University Medical Centre Maastricht (Netherlands)
  5. Department of Surgery, Università Cattolica S. Cuore, Rome (Italy)
  6. Department of Oncology, Hospital General Universitario Gregorio Marañón, Complutense University, Madrid (Spain)
  7. Département de Radiothérapie, CRLC, Montpellier Cedex (France)
  8. Department of Radiotherapy, PMU, Salzburg (Austria)
  9. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)
  10. Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia (United States)
  11. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)
  12. Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland (United States)
  13. Department of Oncology, S. Raffaele Scientific Institute, Milan (Italy)
  14. Department of Radiation Oncology, University Campus Biomedico, Roma (Italy)
Publication Date:
OSTI Identifier:
22420481
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 90; Journal Issue: 4; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; CHEMOTHERAPY; COMPUTERIZED TOMOGRAPHY; DEATH; DIAGNOSIS; LYMPH NODES; METASTASES; MULTIVARIATE ANALYSIS; PANCREAS; PATIENTS; RADIOTHERAPY; REVIEWS; SURGERY