title: Impact of radiation therapy sequence on survival among patients with resected pancreatic head ductal carcinoma.
abstract: BACKGROUND
  Neoadjuvant therapy for pancreatic cancer is increasingly studied, but no randomized data is available to address its clinical utility. The purpose of this study is to compare the impact of the sequencing of radiation therapy and surgery on overall survival (OS) of patients, who received both pancreaticoduodenectomy and radiation therapy.
  
  
  METHODS
  Surveillance, Epidemiology, and End Results data on pancreatic head carcinoma patients diagnosed between 1991 and 2007 was used. OS of patients receiving neoadjuvant (nRT, n=111) versus adjuvant radiation therapy (aRT, n=1839) was the primary end point. Excluded were cases in which resection or radiation therapy were omitted.
  
  
  RESULTS
  The groups were comparable with respect to age (63±9 vs. 62±10years, P=0.490) and gender distribution. Median OS was similar in the nRT and aRT groups (19 vs. 20 months, P=0.688). On multivariate analysis, nodal status (hazard ratio [HR] 1.35, P<0.001) and age (HR 1.01/year, P<0.001) were predictive of OS, but RT sequence was not.
  
  
  CONCLUSIONS
  Survival of patients undergoing pancreaticoduodenectomy for pancreatic head carcinoma does not seem to be affected by sequence of perioperative radiation therapy. This finding would imply that prospective studies comparing nRT to aRT is warranted to examine potential clinical benefits of nRT and can be carried out without compromising patient outcome.
authors: Division of Surgical Oncology, Mercy Medical Center, Des Moines, IA, USA. jan.franko@gmail.com
authors: Jan
authors: J
authors: Franko
authors: Dev R
authors: DR
authors: Puri
authors: Charles D
authors: CD
authors: Goldman
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D018426:SEER Program; D015996:Survival Rate