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Adjuvant chemoradiation may improve survival over adjuvant chemotherapy in resected pancreatic cancer patients who are high risk for locoregional recurrence

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

The objective of the study was to evaluate the benefit of adjuvant chemoradiation compared to adjuvant chemotherapy for resected pancreatic head cancer.

Methods

Three hundred thirty-nine patients (2000–2012) had pancreatoduodenectomy for pancreatic cancer. Chemotherapy was gemcitabine or 5-fluorouracil (5-FU) and radiotherapy was 45–54 Gy. Locoregional recurrences (LRR) were operative bed or regional nodal failures. Logistical regression, Kaplan-Meier estimates, and log-rank tests were used for statistics.

Results

One hundred thirty patients had resection alone (A), 84 had adjuvant chemotherapy (B), and 129 had adjuvant chemoradiation (C). Median follow-up and median survival (MS) for all patients was 17.5 and 19.5 months, respectively. MS for groups A, B, and C were 13, 23, and 26 months, respectively. Groups B and C had R1 resection rates of 37 and 39 % (p = ns). LRR was 60, 63, and 38 % and distant failure was 64, 65, and 66 % for groups A, B, and C, respectively. Group C had significantly lower LRR compared to group B (p = 0.01); however, survival between groups B and C was not statistically different (p = 0.23). On univariate analysis, LRR (p = 0.0038), N-category (p < 0.0001), perineural invasion (PNI; p = 0.007), and R1 resection (p = 0.018) were significant predictors of survival. Multivariable analysis (MVA) showed that LRR (p = 0.004) and N-category (p = 0.01) were predictors of survival. On subgroup analysis, there was improved survival in group C vs B in patients with R1 resection, MS of 27 vs 16 months, respectively (p = 0.01), and in patients with lymph node ratio (LNR) ≤0.2 who had ≥8 LN dissected, MS of 32 vs 24 months (p = 0.04).

Conclusion

Adjuvant chemoradiation significantly decreases LRR in resected pancreatic cancer patients compared to adjuvant chemotherapy. Significant predictors of survival on MVA were LRR and N-category. Additionally on subgroup analysis, chemoradiation improved survival over chemotherapy with a (1) positive surgical margin and/or (2) LNR ≤0.2 with ≥8 LNs dissected.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethics statement

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, 44195, USA

    Aryavarta M. S. Kumar & May Abdel-Wahab

  2. Department of General Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA

    Gavin A. Falk & R. Matthew Walsh

  3. Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, OH, 44195, USA

    Robert Pelley

Authors
  1. Aryavarta M. S. Kumar
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  2. Gavin A. Falk
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  3. Robert Pelley
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  4. R. Matthew Walsh
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  5. May Abdel-Wahab
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Correspondence to Aryavarta M. S. Kumar.

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Kumar, A.M.S., Falk, G.A., Pelley, R. et al. Adjuvant chemoradiation may improve survival over adjuvant chemotherapy in resected pancreatic cancer patients who are high risk for locoregional recurrence. J Radiat Oncol 4, 271–276 (2015). https://doi.org/10.1007/s13566-015-0186-7

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  • DOI: https://doi.org/10.1007/s13566-015-0186-7

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