title: The addition of radiation to chemotherapy does not improve outcome when compared to chemotherapy in the treatment of resected pancreas cancer: the results of a single-institution experience.
abstract: BACKGROUND
  Pancreas cancer is highly lethal even at early stages. Adjuvant therapy with chemotherapy (CT) or chemoradiation (CRT) is standard following surgery to delay recurrence and improve survival. There is no consensus on the added value of radiotherapy (RT). We conducted a retrospective analysis of clinical outcomes in pancreas cancer patients treated with CT or CRT following surgery.
  
  
  METHODS
  Patients with resected pancreas adenocarcinoma were identified in our institutional database. Relevant clinicopathologic and demographic data were collected. Patients were grouped according to adjuvant treatment: group A: no treatment; group B: CT; group C: CRT. The primary endpoint of overall survival was compared between groups B vs. C. Univariate and multivariate analyses of potential prognostic factors were conducted including all patients.
  
  
  RESULTS
  A total of 146 evaluable patients were included (group A: n = 33; group B: n = 45; group C: n = 68). Demographics and pathologic characteristics were comparable. There was no significant survival benefit for CRT compared with CT (mOS 16.8 months vs. 21.5 months, respectively, p = 0.76). Local recurrence rates were similar in all three groups. Univariate analyses identified absence of lymph node involvement (hazards ratio [HR] 1.43, p = 0.0082) and administration of adjuvant therapy (HR 0.496, p = 0.0008) as significant predictors for improved survival. Multivariate analyses suggested that patients without nodal involvement derived the most benefit from adjuvant treatment.
  
  
  CONCLUSIONS
  The addition of RT to CT did not improve survival over CT. Lymph node involvement predicts inferior clinical outcome.
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH.
authors.forename: Ludmila Katherine
authors.initials: LK
authors.lastname: Martin
authors.affiliation: Department of Internal Medicine, The Ohio State University, Columbus, OH.
authors.forename: Dai Chu
authors.initials: DC
authors.lastname: Luu
authors.affiliation: Center for Biostatistics, The Ohio State University, Columbus, OH.
authors.forename: Xiaobai
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Surgery, The Ohio State University, Columbus, OH.
authors.forename: Peter
authors.initials: P
authors.lastname: Muscarella
authors.affiliation: Department of Surgery, The Ohio State University, Columbus, OH.
authors.forename: E Christopher
authors.initials: EC
authors.lastname: Ellison
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH.
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH.
authors.forename: Tanios
authors.initials: T
authors.lastname: Bekaii-Saab
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000401:mortality*; D017024:Chemotherapy, Adjuvant / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate
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