title: Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study.
abstract: BACKGROUND
  Survival for pancreatic ductal adenocarcinoma is low, the role of adjuvant therapy remains controversial, and recent data suggest adjuvant chemoradiation (CRT) may decrease survival compared with surgery alone. Our goal was to examine efficacy of adjuvant CRT in resected pancreatic adenocarcinoma compared with surgery alone.
  
  
  METHODS
  Patients with pancreatic adenocarcinoma at Johns Hopkins Hospital (n = 794, 1993-2005) and Mayo Clinic (n = 478, 1985-2005) following resection who were observed (n = 509) or received adjuvant 5-FU based CRT (median dose 50.4 Gy; n = 583) were included. Cox survival and propensity score analyses assessed associations with overall survival. Matched-pair analysis by treatment group (1:1) based on institution, age, sex, tumor size/stage, differentiation, margin, and node positivity with N = 496 (n = 248 per treatment arm) was performed.
  
  
  RESULTS
  Median survival was 18.8 months. Overall survival (OS) was longer among recipients of CRT versus surgery alone (median survival 21.1 vs. 15.5 months, P < .001; 2- and 5-year OS 44.7 vs. 34.6%; 22.3 vs. 16.1%, P < .001). Compared with surgery alone, adjuvant CRT improved survival in propensity score analysis for all patients by 33% (P < .001), with improved survival when stratified by age, margin, node, and T-stage (RR = 0.57-0.75, P < .05). Matched-pair analysis demonstrated OS was longer with CRT (21.9 vs. 14.3 months median survival; 2- and 5-year OS 45.5 vs. 31.4%; 25.4 vs. 12.2%, P < .001).
  
  
  CONCLUSIONS
  Adjuvant CRT is associated with improved survival after pancreaticoduodenectomy. Adjuvant CRT was not associated with decreased survival in any risk group, even in propensity score and matched-pair analyses. Further studies evaluating adjuvant chemotherapy compared with adjuvant chemoradiation are needed to determine the most effective combination of systemic and local-regional therapy to achieve optimal survival results.
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Hsu
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
authors.forename: Michele M
authors.initials: MM
authors.lastname: Corsini
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Winter
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Callister
authors.forename: Michael G
authors.initials: MG
authors.lastname: Haddock
authors.forename: John L
authors.initials: JL
authors.lastname: Cameron
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Laheru
authors.forename: Michael B
authors.initials: MB
authors.lastname: Farnell
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Swartz
authors.forename: Leonard L
authors.initials: LL
authors.lastname: Gunderson
authors.forename: Robert C
authors.initials: RC
authors.lastname: Miller
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D016577:Pancreaticoduodenectomy; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil