title: A Tale of Two Cities: Reconsidering Adjuvant Radiation in Pancreatic Cancer Care.
abstract: Adjuvant chemotherapy plays a critical role in the treatment of resected pancreatic cancer patients. However, the role of adjuvant radiation remains controversial. This study compares survival between resected pancreatic cancer patients who received adjuvant radiation and no adjuvant radiation. Medical records of patients with pancreatic ductal adenocarcinoma who underwent surgical resection from January 2003 through 2013 at medical centers in Boston and Leiden were retrospectively reviewed. Propensity score matching was used to correct for potential selection bias in the allocation of adjuvant chemoradiation versus chemotherapy alone. Three hundred fifty total patients were identified, of whom 138 (39.4%) received adjuvant radiation. On pathological staging, 245 (70.0%) had positive lymph nodes, and these patients gained a significant survival benefit from adjuvant radiation (hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.56-0.99) in the complete cohort. After propensity score matching, adjuvant radiation lost its prognostic significance in the complete cohort. However, after matching, patients who survived longer than 12 months and had positive lymph nodes (n = 108) demonstrated a significant (log-rank p = 0.04) survival benefit from adjuvant radiation. This study, while non-randomized, suggests that adjuvant radiation may be associated with a survival benefit for resected pancreatic cancer patients in specific situations.
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Susanna W L
authors.initials: SW
authors.lastname: de Geus
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Bliss
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Mariam F
authors.initials: MF
authors.lastname: Eskander
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Sing Chau
authors.initials: SC
authors.lastname: Ng
authors.affiliation: Department of Surgery, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Vahrmeijer
authors.affiliation: Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Stoneman 913, Boston, MA, 02215, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Mahadevan
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Tara S
authors.initials: TS
authors.lastname: Kent
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: A James
authors.initials: AJ
authors.lastname: Moser
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Callery
authors.affiliation: Department of Surgery, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands.
authors.forename: Bert A
authors.initials: BA
authors.lastname: Bonsing
authors.affiliation: Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. jftseng@bidmc.harvard.edu.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Tseng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Adjuvant chemoradiotherapy; Adjuvant radiotherapy; Pancreatic neoplasm; Survival