title: Adjuvant chemoradiation therapy after pancreaticoduodenectomy in elderly patients with pancreatic adenocarcinoma.
abstract: OBJECTIVE
  To evaluate the efficacy of adjuvant chemoradiation therapy (CRT) for pancreatic adenocarcinoma patients ≥ 75 years of age.
  
  
  METHODS
  The study group of 655 patients underwent pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma at the Johns Hopkins Hospital over a 12-year period (8/30/1993 to 2/28/2005). Demographic characteristics, comorbidities, intraoperative data, pathology data, and patient outcomes were collected and analyzed by adjuvant treatment status and age ≥ 75 years. Cox proportional hazards analysis determined clinical predictors of mortality and morbidity.
  
  
  RESULTS
  We identified 166 of 655 (25.3%) patients were ≥ 75 years of age and 489 of 655 patients (74.7%) were <75 years of age. Forty-nine patients in the elderly group (29.5%) received adjuvant CRT. For elderly patients, node-positive metastases (p = 0.008), poor/anaplastic differentiation (p = 0.012), and undergoing a total pancreatectomy (p = 0.010) predicted poor survival. The 2-year survival for elderly patients receiving adjuvant therapy was improved compared with surgery alone (49.0% vs. 31.6%, p = 0.013); however, 5-year survival was similar (11.7% vs. 19.8%, respectively, p = 0.310). After adjusting for major confounders, adjuvant therapy in elderly patients had a protective effect with respect to 2-year survival (relative risk [RR] 0.58, p = 0.044), but not 5-year survival (RR 0.80, p = 0.258). Among the nonelderly, CRT was significantly associated with 2-year survival (RR 0.60, p < 0.001) and 5-year survival (RR 0.69, p < 0.001), after adjusting for confounders.
  
  
  CONCLUSIONS
  Adjuvant therapy after PD is significantly associated with increased 2-year but not 5-year survival in elderly patients. Additional studies are needed to select which elderly patients are likely to benefit from adjuvant CRT.
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Horowitz
authors.forename: Charles C
authors.initials: CC
authors.lastname: Hsu
authors.forename: Jingya
authors.initials: J
authors.lastname: Wang
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Winter
authors.forename: Ray
authors.initials: R
authors.lastname: Robinson
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: John L
authors.initials: JL
authors.lastname: Cameron
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000069287:Capecitabine; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods / Q000401:mortality; D011182:Postoperative Care / Q000379:methods; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000379:methods; D016019:Survival Analysis
chemical_list: D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil