title: Resection status, age and nodal involvement determine survival among patients receiving adjuvant chemoradiotherapy in pancreatic adenocarcinoma.
abstract: BACKGROUND
  Pancreas cancer can potentially be cured by resection, but the role of adjuvant chemotherapy and/or chemoradiation has been controversial.
  
  
  OBJECTIVE
  To better define clinicopathological factors that may serve as predictive and/or prognostic variables.
  
  
  METHODS
  Between 1984 and 2006, we retrospectively analyzed 91 patients with pancreas cancer treated with pancreaticoduodenectomy or total pancreatectomy followed by adjuvant 5-fluorouracil-based chemoradiation at the University of Pennsylvania. Final pathological coding including margin status was confirmed by a pathologist.
  
  
  METHODS
  Patients were treated with 48.6 to 63.0 Gy, and 96.7% completed their prescribed radiation dose.
  
  
  METHODS
  The prognostic significance of demographic factors, stage, year of surgery, tumor location, grade, resection status, and number of positive lymph nodes on overall survival were examined.
  
  
  RESULTS
  With a median follow-up of 6.5 years, the overall median survival was 2.3 years (95% CI 1.5-3.2 years), and the 5-year overall survival was 28.9%. In multivariate analysis, completeness of resection (P<0.001), fewer number of positive lymph nodes (0 vs. 1-2 vs. 3 or more) (P=0.004), and age less than, or equal to, 60 years (P=0.006) were all independently associated with improved overall survival. The overall survival reported in this study compares favorably with the results of other single-institution studies and with the RTOG 97-04 trial.
  
  
  CONCLUSIONS
  Adjuvant 5-FU-based chemoradiation following radical pancreatectomy can be delivered safely and results in comparatively good overall survival. The results of this analysis underscore the importance of resection status, number of involved lymph nodes and patient age as prognostic characteristics. These factors may be considered stratification variables for future post-pancreatectomy adjuvant therapy trials.
authors: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
authors: Drew
authors: D
authors: Moghanaki
authors: Rosemarie
authors: R
authors: Mick
authors: Emma Elizabeth
authors: EE
authors: Furth
authors: Davendra
authors: D
authors: Sohal
authors: Patricia M
authors: PM
authors: Salmon
authors: Ali
authors: A
authors: Behbahani
authors: Alicia K
authors: AK
authors: Morgans
authors: Seth M
authors: SM
authors: Miller
authors: Bruce J
authors: BJ
authors: Giantonio
authors: Richard W
authors: RW
authors: Whittington
authors: Daniel G
authors: DG
authors: Haller
authors: Ernest F
authors: EF
authors: Rosato
authors: John P
authors: JP
authors: Plastaras
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000706:statistics & numerical data*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis