title: Adjuvant chemoradiation therapy for adenocarcinoma of the distal pancreas.
abstract: BACKGROUND
  This study was designed to examine the effect of adjuvant 5-FU-based chemoradiation therapy (CRT) after distal pancreatectomy for adenocarcinoma of the distal pancreas.
  
  
  METHODS
  All patients underwent curative resection for adenocarcinoma of the distal pancreas between December 1985 and June 2006. Patients who received adjuvant CRT were compared with those who underwent surgery alone. A Kaplan-Meier estimate of the survival curve was used to determine estimates of the median survival and proportion alive at 1 and 2 years; log-rank tests were used to make comparisons between groups.
  
  
  RESULTS
  A total of 123 patients underwent distal pancreatectomy; 29 patients were excluded for distant metastases at the time of surgery (n = 12, 10%) or before adjuvant therapy (n = 11, 9%), death within 2 months of surgery (n = 2, 2%), or if CRT treatment status was unknown (n = 4, 3%). Of the remaining 94 patients, 72% received adjuvant 5-FU-based CRT and 28% underwent surgery alone. Overall median survival was 16.2 (95% confidence interval (CI), 13.1-18.9) months. The groups were similar with respect to tumor size, nodal status, and margin status. There was no significant difference in overall survival between patients treated with adjuvant CRT versus surgery alone (p = 0.23). An exploratory subgroup analysis suggested a potential survival benefit of adjuvant CRT in patients with lymph node metastases (16.7 vs. 12.1 months, p < 0.01).
  
  
  CONCLUSIONS
  Adjuvant CRT did not increase survival compared with surgery alone; however, patients with node-positive disease appear to benefit from adjuvant CRT.
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Kristin J
authors.initials: KJ
authors.lastname: Redmond
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sugar
authors.forename: Julia
authors.initials: J
authors.lastname: Ahn
authors.forename: Hari
authors.initials: H
authors.lastname: Nathan
authors.forename: Daniel
authors.initials: D
authors.lastname: Laheru
authors.forename: Barish H
authors.initials: BH
authors.lastname: Edil
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hruban
authors.forename: John L
authors.initials: JL
authors.lastname: Cameron
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000532:radiotherapy* / Q000556:secondary; 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; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil