title: Multi-institutional pooled analysis on adjuvant chemoradiation in pancreatic cancer.
abstract: OBJECTIVE
  To determine the impact of chemoradiation therapy (CRT) on overall survival (OS) after resection of pancreatic adenocarcinoma.
  
  
  METHODS
  A multicenter retrospective review of 955 consecutive patients who underwent complete resection with macroscopically negative margins (R0-1) for invasive carcinoma (T1-4; N0-1; M0) of the pancreas was performed. Exclusion criteria included metastatic or unresectable disease at surgery, macroscopic residual disease (R2), treatment with intraoperative radiation therapy (IORT), and a histological diagnosis of no ductal carcinoma, or postoperative death (within 60 days of surgery). In all, 623 patients received postoperative radiation therapy (RT), 575 patients received concurrent chemotherapy (CT), and 462 patients received adjuvant CT.
  
  
  RESULTS
  Median follow-up was 21.0 months. Median OS after adjuvant CRT was 39.9 versus 24.8 months after no adjuvant CRT (P<.001) and 27.8 months after CT alone (P<.001). Five-year OS was 41.2% versus 24.8% with and without postoperative CRT, respectively. The positive impact of CRT was confirmed by multivariate analysis (hazard ratio [HR] = 0.72; confidence interval [CI], 0.60-0.87; P=.001). Adverse prognostic factors identified by multivariate analysis included the following: R1 resection (HR = 1.17; CI = 1.07-1.28; P<.001), higher pT stage (HR = 1.23; CI = 1.11-1.37; P<.001), positive lymph nodes (HR = 1.27; CI = 1.15-1.41; P<.001), and tumor diameter >20 mm (HR = 1.14; CI = 1.05-1.23; P=.002). Multivariate analysis also showed a better prognosis in patients treated in centers with >10 pancreatic resections per year (HR = 0.87; CI = 0.78-0.97; P=.014) CONCLUSION: This study represents the largest comparative study on adjuvant therapy in patients after resection of carcinoma of the pancreas. Overall survival was better in patients who received adjuvant CRT.
authors.affiliation: Department of Radiotherapy, Università Cattolica S. Cuore, Rome, Italy; Unit of Radiotherapy, Unit of General Oncology, Fondazione Giovanni Paolo II, Campobasso, Italy.
authors.forename: Alessio G
authors.initials: AG
authors.lastname: Morganti
authors.affiliation: Department of Surgery, University of Verona, Verona, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW, University Medical Centre Maastricht, The Netherlands.
authors.forename: Ruud G P M
authors.initials: RG
authors.lastname: van Stiphout
authors.affiliation: Department of Radiotherapy, Università Cattolica S. Cuore, Rome, Italy. Electronic address: gcmattiucci@rm.unicatt.it.
authors.forename: Gian-Carlo
authors.initials: GC
authors.lastname: Mattiucci
authors.affiliation: Department of Surgery, Università Cattolica S. Cuore, Rome, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Alfieri
authors.affiliation: Department of Oncology, Hospital General Universitario Gregorio Marañón, Complutense University, Madrid, Spain.
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Calvo
authors.affiliation: Département de Radiothérapie, CRLC, Montpellier Cedex, France.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Dubois
authors.affiliation: Department of Radiotherapy, PMU, Salzburg, Austria.
authors.forename: Gerd
authors.initials: G
authors.lastname: Fastner
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
authors.affiliation: Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia.
authors.forename: Bert W
authors.initials: BW
authors.lastname: Maidment
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Miller
authors.affiliation: Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: William F
authors.initials: WF
authors.lastname: Regine
authors.affiliation: Department of Oncology, S. Raffaele Scientific Institute, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Reni
authors.affiliation: Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: Navesh K
authors.initials: NK
authors.lastname: Sharma
authors.affiliation: Department of Radiation Oncology, University Campus Biomedico, Roma, Italy.
authors.forename: Edy
authors.initials: E
authors.lastname: Ippolito
authors.affiliation: Department of Radiotherapy, Università Cattolica S. Cuore, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000401:mortality*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult