Adjuvant chemoradiation therapy for pancreatic adenocarcinoma: who really benefits?
BACKGROUND
The role of adjuvant chemoradiation therapy (CRT) in pancreatic cancer remains controversial. The primary aim of this study was to determine if CRT improved survival in patients with resected pancreatic cancer in a large, multiinstitutional cohort of patients.


METHODS
Patients undergoing resection for pancreatic adenocarcinoma from seven academic medical institutions were included. Exclusion criteria included patients with T4 or M1 disease, R2 resection margin, preoperative therapy, chemotherapy alone, or if adjuvant therapy status was unknown.


RESULTS
There were 747 patients included in the initial evaluation. Primary analysis was performed between patients that had surgery alone (n=374) and those receiving adjuvant CRT (n=299). Median followup time was 12.2 months and 14.5 months for survivors. Median overall survival for patients receiving adjuvant CRT was significantly longer than for those undergoing operation alone (20.0 months versus 14.5 months, p=0.001). On subset and multivariate analysis, adjuvant CRT demonstrated a significant survival advantage only among patients who had lymph node (LN)-positive disease (hazard ratio 0.477, 95% CI 0.357 to 0.638) and not for LN-negative patients (hazard ratio 0.810, 95% CI 0.556 to 1.181). Disease-free survival in patients with LN-negative disease who received adjuvant CRT was significantly worse than in patients who had surgery alone (14.5 months versus 18.6 months, p=0.034).


CONCLUSIONS
This large multiinstitutional study emphasizes the importance of analyzing subsets of patients with pancreas adenocarcinoma who have LN metastasis. Benefit of adjuvant CRT is seen only in patients with LN-positive disease, regardless of resection margin status. CRT in patients with LN-negative disease may contribute to reduced disease-free survival.
Merchant
Nipun B
NB
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-6860, USA.
Rymer
Jennifer
J
Koehler
Elizabeth A S
EA
Ayers
G Daniel
GD
Castellanos
Jason
J
Kooby
David A
DA
Weber
Sharon H
SH
Cho
Clifford S
CS
Schmidt
C Max
CM
Nakeeb
Atilla
A
Matos
Jesus M
JM
Scoggins
Charles R
CR
Martin
Robert C G
RC
Kim
Hong Jin
HJ
Ahmad
Syed A
SA
Chu
Carrie K
CK
McClaine
Rebecca
R
Bednarski
Brian K
BK
Staley
Charles A
CA
Sharp
Kenneth
K
Parikh
Alexander A
AA
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis