title: Early vs. Late Chemoradiation Therapy and the Postoperative Interval to Adjuvant Therapy Do Not Correspond to Local Recurrence in Resected Pancreatic Cancer.
abstract: OBJECTIVE
  Standard postoperative therapy for pancreatic cancer consists of both chemotherapy alone and chemoradiation. We sought to investigate whether the sequence of chemotherapy and chemoradiation and overall time to initiation of adjuvant therapy would impact local vs. distant recurrence.
  
  
  METHODS
  After Institutional Review Board approval, resected pancreas cancer patient charts were evaluated for medical background, surgical, pathological, chemoradiation (CRT), and follow-up. Local recurrence (LR) was defined as failures occurring in the postoperative bed and regional lymph nodes. Early vs. late CRT was defined by whether CRT was given early (within 1-2 cycles of adjuvant chemotherapy) or late in the course of adjuvant chemotherapy (after the 3rd cycle of chemotherapy). The postoperative interval variance was compared to LR factors such as progression-free survival (PFS) and overall survival (OS).
  
  
  RESULTS
  Of the 34 eligible patients, 47% (n=16) underwent early CRT and 41% (n=14) underwent late CRT. 12% (n=14) did not undergo any induction chemotherapy. At median follow-up of 22 months, 53% (n=18) had metastases, 24% (n=8) had LR, and 24% (n=8) were disease free. Kaplan-Meier curves revealed that early vs. late CRT did not appear to significantly impact OS (p=0.63), PFS (p=0.085) or LR (p=0.19). Postoperative interval did not affect PFS (p=0.42) or OS (p=0.93).
  
  
  CONCLUSIONS
  Early vs. late CRT and the time to initiation of adjuvant therapy were not significantly associated with LR in patients with resected pancreatic cancer. Future prospective studies are required to determine if sequencing of chemotherapy, CRT, or the postoperative interval impact survival and patterns of recurrence.
authors.affiliation: Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, State University of New Jersey, USA.
authors.forename: Ajay A
authors.initials: AA
authors.lastname: Patel
authors.affiliation: Center on Genomics, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA.
authors.forename: Sairaman
authors.initials: S
authors.lastname: Nagarajan
authors.affiliation: Rowan University School of Osteopathic Medicine, Stratford NJ, USA.
authors.forename: Eli D
authors.initials: ED
authors.lastname: Scher
authors.affiliation: Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, State University of New Jersey, USA; Department of Radiation Oncology, University of Pennsylvania, Philadelphia PA, USA.
authors.forename: Caitlin Ab
authors.initials: CA
authors.lastname: Schonewolf
authors.affiliation: Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, State University of New Jersey, USA.
authors.forename: Sairam
authors.initials: S
authors.lastname: Balasubramanian
authors.affiliation: Department of Medicine, Division of Medical Oncology, Cancer Institute of New Jersey.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Poplin
authors.affiliation: Department of Medicine, Division of Medical Oncology, Cancer Institute of New Jersey.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Moss
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick NJ, USA.
authors.forename: David
authors.initials: D
authors.lastname: August
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick NJ, USA.
authors.forename: Darren
authors.initials: D
authors.lastname: Carpizo
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick NJ, USA.
authors.forename: Laleh
authors.initials: L
authors.lastname: Melstrom
authors.affiliation: Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, State University of New Jersey, USA.
authors.forename: Salma K
authors.initials: SK
authors.lastname: Jabbour
keywords: Adjuvant therapy; Chemoradiation; Interval; Pancreas; Recurrence; Sequencing; Survival