title: Adjuvant Chemoradiation in Pancreatic Cancer: A Pooled Analysis in Elderly (≥75 years) Patients.
abstract: OBJECTIVE
  To determine the impact of postoperative chemoradiation (POCR) on overall survival (OS) after resection of pancreatic adenocarcinoma (PAC) in elderly (≥75 years) patients.
  
  
  METHODS
  A multi-center retrospective review of 1248 patients who underwent complete resection with macroscopically negative margins (R0-1) for invasive PAC was performed. Exclusion criteria included age <75 years, metastatic or unresectable disease at surgery, macroscopic residual disease (R2), treatment with intraoperative radiotherapy (IORT) and postoperative death.
  
  
  RESULTS
  A total of 98 patients were included in the analysis (males=39.8%, females=60.2%; R1 resections=33.7%; pN1=61.2%); 63 patients received POCR and 26 patients received adjuvant chemotherapy alone. The median follow-up was 25.6 months. The mean age for the entire cohort of patients was 78.1±2.9 (SD) years. No differences were observed between patients receiving or not receiving POCR in terms of age (p=0.081), tumor diameter (p=0.412), rate of R1 resection (p=0.331) and incidence of lymph node-positive disease (p=0.078). The only factor predicting an improved OS was POCR. The median OS was 69.0 months in patients treated by POCR and 23.0 months in patients treated without POCR (p=0.008). Even by Cox multivariate analysis, the only significant predictor of OS was POCR (hazard ratio=0.449; 95% confidence interval=0.212-0.950; p=0.036).
  
  
  CONCLUSIONS
  The study represents the first comparative approach on POCR in elderly patients after resection of PAC. OS was higher in patients who received POCR. Further analyses are warranted to evaluate the toxicity rate/grade and the impact of POCR on patient quality of life.
authors.affiliation: Department of Radiotherapy, Sacro Cuore Catholic University, Rome, Italy gcmattiucci@rm.unicatt.it.
authors.forename: Gian-Carlo
authors.initials: GC
authors.lastname: Mattiucci
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 Surgery, Sacro Cuore Catholic University, Rome, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Alfieri
authors.affiliation: Department of Oncology, Gregorio Marañón General Hospital, Complutense University, Madrid, Spain.
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Calvo
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
authors.affiliation: Department of Radiation Oncology, University of Virginia, Charlottesville, VA, U.S.A.
authors.forename: Bert W
authors.initials: BW
authors.lastname: Maidment
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN, U.S.A.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Miller
authors.affiliation: Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, U.S.A.
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, MD, U.S.A.
authors.forename: Navesh
authors.initials: N
authors.lastname: Sharma
authors.affiliation: Department of Radiotherapy, Sacro Cuore Catholic University, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Partelli
authors.affiliation: Department of Radiotherapy, SS Annunziata Hospital, G. D'Annunzio University, Chieti, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Genovesi
authors.affiliation: Department of Radiotherapy, Sacro Cuore Catholic University, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Balducci
authors.affiliation: Unit of Radiotherapy, Unit of General Oncology, Giovanni Paolo II Foundation, Campobasso, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Deodato
authors.affiliation: Department of Radiotherapy, Sacro Cuore Catholic University, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.affiliation: Unit of Radiotherapy, Unit of General Oncology, Giovanni Paolo II Foundation, Campobasso, Italy.
authors.forename: Alessio G
authors.initials: AG
authors.lastname: Morganti
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy*; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
keywords: Pancreatic cancer; adjuvant; aged; chemotherapy; multicenter study; pooled analysis; radiotherapy