Multi-institutional pooled analysis on adjuvant chemoradiation in pancreatic cancer

Alessio G. Morganti, Massimo Falconi, Ruud G P M Van Stiphout, Gian Carlo Mattiucci, Sergio Alfieri, Felipe A. Calvo, Jean Bernard Dubois, Gerd Fastner, Joseph M. Herman, Bert W. Maidment, Robert C. Miller, William F. Regine, Michele Reni, Navesh K. Sharma, Edy Ippolito, Vincenzo Valentini

Research output: Chapter in Book/Report/Conference proceedingChapter

31 Citations (Scopus)

Abstract

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; 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.

Original languageEnglish (US)
Title of host publicationInternational Journal of Radiation Oncology Biology Physics
PublisherElsevier Inc.
Pages911-917
Number of pages7
Volume90
Edition4
DOIs
StatePublished - Nov 15 2014

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Pancreatic Neoplasms
cancer
therapy
pancreas
chemotherapy
surgery
Survival
Pancreas
radiation therapy
Radiotherapy
Therapeutics
Carcinoma
Ductal Carcinoma
prognosis
Adjuvant Chemotherapy
exclusion
Ambulatory Surgical Procedures
death
margins
Adenocarcinoma

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research
  • Medicine(all)

Cite this

Morganti, A. G., Falconi, M., Van Stiphout, R. G. P. M., Mattiucci, G. C., Alfieri, S., Calvo, F. A., ... Valentini, V. (2014). Multi-institutional pooled analysis on adjuvant chemoradiation in pancreatic cancer. In International Journal of Radiation Oncology Biology Physics (4 ed., Vol. 90, pp. 911-917). Elsevier Inc.. https://doi.org/10.1016/j.ijrobp.2014.07.024

Multi-institutional pooled analysis on adjuvant chemoradiation in pancreatic cancer. / Morganti, Alessio G.; Falconi, Massimo; Van Stiphout, Ruud G P M; Mattiucci, Gian Carlo; Alfieri, Sergio; Calvo, Felipe A.; Dubois, Jean Bernard; Fastner, Gerd; Herman, Joseph M.; Maidment, Bert W.; Miller, Robert C.; Regine, William F.; Reni, Michele; Sharma, Navesh K.; Ippolito, Edy; Valentini, Vincenzo.

International Journal of Radiation Oncology Biology Physics. Vol. 90 4. ed. Elsevier Inc., 2014. p. 911-917.

Research output: Chapter in Book/Report/Conference proceedingChapter

Morganti, AG, Falconi, M, Van Stiphout, RGPM, Mattiucci, GC, Alfieri, S, Calvo, FA, Dubois, JB, Fastner, G, Herman, JM, Maidment, BW, Miller, RC, Regine, WF, Reni, M, Sharma, NK, Ippolito, E & Valentini, V 2014, Multi-institutional pooled analysis on adjuvant chemoradiation in pancreatic cancer. in International Journal of Radiation Oncology Biology Physics. 4 edn, vol. 90, Elsevier Inc., pp. 911-917. https://doi.org/10.1016/j.ijrobp.2014.07.024
Morganti AG, Falconi M, Van Stiphout RGPM, Mattiucci GC, Alfieri S, Calvo FA et al. Multi-institutional pooled analysis on adjuvant chemoradiation in pancreatic cancer. In International Journal of Radiation Oncology Biology Physics. 4 ed. Vol. 90. Elsevier Inc. 2014. p. 911-917 https://doi.org/10.1016/j.ijrobp.2014.07.024
Morganti, Alessio G. ; Falconi, Massimo ; Van Stiphout, Ruud G P M ; Mattiucci, Gian Carlo ; Alfieri, Sergio ; Calvo, Felipe A. ; Dubois, Jean Bernard ; Fastner, Gerd ; Herman, Joseph M. ; Maidment, Bert W. ; Miller, Robert C. ; Regine, William F. ; Reni, Michele ; Sharma, Navesh K. ; Ippolito, Edy ; Valentini, Vincenzo. / Multi-institutional pooled analysis on adjuvant chemoradiation in pancreatic cancer. International Journal of Radiation Oncology Biology Physics. Vol. 90 4. ed. Elsevier Inc., 2014. pp. 911-917
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author = "Morganti, {Alessio G.} and Massimo Falconi and {Van Stiphout}, {Ruud G P M} and Mattiucci, {Gian Carlo} and Sergio Alfieri and Calvo, {Felipe A.} and Dubois, {Jean Bernard} and Gerd Fastner and Herman, {Joseph M.} and Maidment, {Bert W.} and Miller, {Robert C.} and Regine, {William F.} and Michele Reni and Sharma, {Navesh K.} and Edy Ippolito and Vincenzo Valentini",
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AU - Morganti, Alessio G.

AU - Falconi, Massimo

AU - Van Stiphout, Ruud G P M

AU - Mattiucci, Gian Carlo

AU - Alfieri, Sergio

AU - Calvo, Felipe A.

AU - Dubois, Jean Bernard

AU - Fastner, Gerd

AU - Herman, Joseph M.

AU - Maidment, Bert W.

AU - Miller, Robert C.

AU - Regine, William F.

AU - Reni, Michele

AU - Sharma, Navesh K.

AU - Ippolito, Edy

AU - Valentini, Vincenzo

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N2 - 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; 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.

AB - 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; 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.

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