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: Contribution to journalArticle

35 Scopus citations

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)
Pages (from-to)911-917
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume90
Issue number4
DOIs
StatePublished - Nov 15 2014

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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    Morganti, A. G., Falconi, M., Van Stiphout, R. G. P. M., Mattiucci, G. C., Alfieri, S., Calvo, F. A., Dubois, J. B., Fastner, G., Herman, J. M., Maidment, B. W., Miller, R. C., Regine, W. F., Reni, M., Sharma, N. K., Ippolito, E., & Valentini, V. (2014). Multi-institutional pooled analysis on adjuvant chemoradiation in pancreatic cancer. International Journal of Radiation Oncology Biology Physics, 90(4), 911-917. https://doi.org/10.1016/j.ijrobp.2014.07.024