title: Chemotherapy and radiation components of neoadjuvant treatment of pancreatic head adenocarcinoma: Impact on perioperative mortality and long-term survival.
abstract: BACKGROUND
  We compared outcomes of neoadjuvant therapy delivered as chemotherapy-only (Chemo) versus concurrent chemoradiation (ChemoRT) versus chemotherapy followed by radiation (Chemo-ChemoRT) among pancreatic head adenocarcinoma patients receiving pancreaticoduodenectomy.
  
  
  METHODS
  National Cancer Data Base cases diagnosed 2006-2011 treated by neoadjuvant therapy and pancreaticoduodenectomy.
  
  
  RESULTS
  1163 pts received neoadjuvant treatment with Chemo (n = 309; 26.6%), ChemoRT (n = 626; 53.8%), or Chemo-ChemoRT (n = 228; 19.6%). Odds of 30-day and 90-day mortality were not influenced by delivery of any neoadjuvant therapy type. Median overall survival for Chemo, ChemoRT, and Chemo-ChemoRT groups were 25.6 (95% confidence interval 23.1-28.7), 22.9 (21.4-24.8), and 26.9 (23.7-29.4) months, respectively. There was no statistically significant difference between Chemo and Chemo-ChemoRT groups (log rank test p = 0.854), while there was significant difference of ChemoRT (p = 0.017 versus Chemo; p = 0.021 versus Chemo-ChemoRT). Multivariate model suggests delivery of concurrent ChemoRT as opposed to neoadjuvant therapy with full dose systemic chemotherapy is associated with shortened survival (aHR = 1.311, p = 0.001).
  
  
  CONCLUSIONS
  There is no detectable difference in early outcomes (30-day and 90-day postsurgical mortality) among pancreaticoduodenectomy patients treated with various types of neoadjuvant therapy. Overall survival appears better among patients exposed preoperatively to full dose systemic chemotherapy rather than concurrent chemoradiation only. Further studies with more detailed data sources are needed.
authors.affiliation: Mercy Medical Center, Des Moines, IA, USA. Electronic address: jan.franko@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Franko
authors.affiliation: Mercy Medical Center, Des Moines, IA, USA.
authors.forename: H W
authors.initials: HW
authors.lastname: Hsu
authors.affiliation: MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: P
authors.initials: P
authors.lastname: Thirunavukarasu
authors.affiliation: Mercy Medical Center, Des Moines, IA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Frankova
authors.affiliation: Mercy Medical Center, Des Moines, IA, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Goldman
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000628:therapy*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000628:therapy*; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents
keywords: Chemoradiation; Chemotherapy; Pancreatic cancer; Preoperative systemic therapy; Resection; Whipple procedure