title: Longer Course of Induction Chemotherapy Followed by Chemoradiation Favors Better Survival Outcomes for Patients With Locally Advanced Pancreatic Cancer.
abstract: OBJECTIVE
  At diagnosis, 30% of patients with pancreatic cancer are unresectable stage 3 locally advanced. The standard treatment for locally advanced pancreatic cancer (LAPC) is not defined. The current study was conducted to assess the roles of chemotherapy and chemoradiation for LAPC treatment.
  
  
  METHODS
  Between June 2006 and March 2011, 100 patients with LAPC were treated at the Johns Hopkins Hospital. Retrospective analysis was performed to compare cumulative incidence of progression (CIP) and overall survival (OS) among different subgroups.
  
  
  RESULTS
  For the 100 patients, the median OS was 15.8 months and the median CIP was 8.4 months. The combination of chemotherapy and chemoradiation before disease progression was significantly associated with improved CIP (P=0.001) and improved OS when compared with chemoradiation alone (median OS: 16.4 vs. 11.1 mo, P=0.03). Among patients receiving combination treatment, patients who received chemotherapy first followed by chemoradiation had a trend toward lower CIP (P=0.09) and improved OS (median OS: 18.1 vs. 11.0 mo, P=0.09). Patients who received >2 cycles of chemotherapy before chemoradiation had a significantly decreased CIP (P=0.008) and a trend toward better OS (median OS: 19.4 vs. 15.7 mo, P=0.10). On multivariate analysis, receiving >2 cycles of chemotherapy before chemoradiation was associated with improved CIP.
  
  
  CONCLUSIONS
  Although combination chemotherapy and chemoradiation is favored in the treatment of LAPC, longer induction chemotherapy may play a more important role in sensitization of tumors to subsequent chemoradiation. Our results support treating patients with induction chemotherapy for at least 3 cycles followed by consolidative chemoradiation. These results merit further validation by a prospective study.
authors.affiliation: *Departments of Oncology, Surgery, and Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD †Department of Surgery, University of Colorado School of Medicine, Denver, CO.
authors.forename: Farzana
authors.initials: F
authors.lastname: Faisal
authors.forename: Hua-Ling
authors.initials: HL
authors.lastname: Tsai
authors.forename: Amanda
authors.initials: A
authors.lastname: Blackford
authors.forename: Kelly
authors.initials: K
authors.lastname: Olino
authors.forename: Chang
authors.initials: C
authors.lastname: Xia
authors.forename: Ana
authors.initials: A
authors.lastname: De Jesus-Acosta
authors.forename: Dung T
authors.initials: DT
authors.lastname: Le
authors.forename: David
authors.initials: D
authors.lastname: Cosgrove
authors.forename: Nilofer
authors.initials: N
authors.lastname: Azad
authors.forename: Zeshaan
authors.initials: Z
authors.lastname: Rasheed
authors.forename: Luis A
authors.initials: LA
authors.lastname: Diaz
authors.forename: Ross
authors.initials: R
authors.lastname: Donehower
authors.forename: Daniel
authors.initials: D
authors.lastname: Laheru
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hruban
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.forename: Barish H
authors.initials: BH
authors.lastname: Edil
authors.forename: Richard
authors.initials: R
authors.lastname: Schulick
authors.forename: Christopher
authors.initials: C
authors.lastname: Wolfgang
authors.forename: Joseph
authors.initials: J
authors.lastname: Herman
authors.forename: Lei
authors.initials: L
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069287:Capecitabine / Q000008:administration & dosage; D059248:Chemoradiotherapy; D015331:Cohort Studies; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil; D000093542:Gemcitabine