title: Adjuvant Gemcitabine and Gemcitabine-based Chemoradiotherapy Versus Gemcitabine Alone After Pancreatic Cancer Resection: The Indiana University Experience.
abstract: Adjuvant therapy after surgical resection is the current standard for pancreatic adenocarcinoma; however, the role of chemoradiotherapy (CRT) remains unclear. This study was conducted to compare the efficacy outcomes with adjuvant gemcitabine and gemcitabine-based CRT (CT-CRT) versus gemcitabine chemotherapy (CT) alone after pancreaticoduodenectomy.
  
  
  
  Among 165 patients who underwent surgical resection for pancreatic cancer at Indiana University Medical Center between 2004 and 2008, we retrospectively identified 53 consecutive patients who received adjuvant therapy (CT-CRT=34 patients; CT=19 patients) and had adequate follow-up medical records. The median follow-up was 19.1 months. Median disease-free (DFS) and overall survival (OS) were determined using Kaplan-Meier method, and a Cox-regression model was used to compare survival outcomes after adjusting for age, status of resection margins, and lymph node involvement.
  
  
  
  The OS for the CT-CRT group was significantly higher compared with the CT group (median, 20.4 vs. 16.6 mo; hazard ratio, 2.42; 95% CI, 1.17-5.01). The median DFS for the CT-CRT group was 13.7 versus 11.1 months for the CT group (hazard ratio, 2.88; 95% CI, 1.37-6.06). On subgroup analyses, significantly superior OS and DFS were observed among patients younger than 65 years, T3/T4 tumor stage, negative resection margins, and positive lymph node involvement.
  
  
  
  Gemcitabine plus gemcitabine-based CRT compared with gemcitabine alone leads to superior DFS and OS for patients with resected pancreatic cancer.
authors.affiliation: *Division of Hematology/Oncology Departments of †Biostatistics ‡Surgery §Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN ∥Department of Medicine, Division of Hematology/Oncology, University of Washington, Seattle, WA.
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Khawaja
authors.forename: Svetlana
authors.initials: S
authors.lastname: Kleyman
authors.forename: Zhangsheng
authors.initials: Z
authors.lastname: Yu
authors.forename: Thomas
authors.initials: T
authors.lastname: Howard
authors.forename: Matthew
authors.initials: M
authors.lastname: Burns
authors.forename: Attila
authors.initials: A
authors.lastname: Nakeeb
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Loehrer
authors.forename: Higinia R
authors.initials: HR
authors.lastname: Cardenes
authors.forename: Elena Gabriela
authors.initials: EG
authors.lastname: Chiorean
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007196:Indiana; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000628:therapy*; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D014495:Universities; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine