title: Neoadjuvant external beam radiation is associated with No benefit in overall survival for early stage pancreatic cancer.
abstract: OBJECTIVE
  Neoadjuvant protocols for early stage pancreatic adenocarcinoma (PDAC) frequently involve external beam radiation used in combination with systemic chemotherapy. The benefit of radiation in these protocols has not been determined.
  
  
  METHODS
  We examined patients with stage I and II PDAC within the National Cancer Data Base between 2006 and 2012. Propensity score matching was used to compare patients receiving neoadjuvant chemotherapy including radiation (NCRT) to those receiving neoadjuvant chemotherapy without radiation (NCT) prior to pancreaticoduodenectomy.
  
  
  RESULTS
  Prior to matching, NCRT patients had higher rates of T3 tumors (P = 0.046) and vascular abutment (P < 0.001). Propensity score matching (1:1) yielded 397 patients per group. Patients treated with NCRT were more likely to have node negative resections (P < 0.001) but had increased rates of 90-day mortality (P = 0.015) and demonstrated a trend towards shorter overall survival (P = 0.0502) than those receiving NCT.
  
  
  CONCLUSIONS
  In early stage PDAC, the addition of radiation to NCT is often utilized with more advanced disease and is associated with higher perioperative mortality and no long-term overall survival benefit.
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States.
authors.forename: Waseem
authors.initials: W
authors.lastname: Lutfi
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Talamonti
authors.affiliation: Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States.
authors.forename: Olga
authors.initials: O
authors.lastname: Kantor
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States.
authors.forename: Chi-Hsiung
authors.initials: CH
authors.lastname: Wang
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Stocker
authors.affiliation: Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentrem
authors.affiliation: Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Roggin
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States.
authors.forename: David J
authors.initials: DJ
authors.lastname: Winchester
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Marsh
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Prinz
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States. Electronic address: mbaker3@northshore.org.
authors.forename: Marshall S
authors.initials: MS
authors.lastname: Baker
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016577:Pancreaticoduodenectomy; D057216:Propensity Score; D018714:Radiotherapy, Adjuvant; D014481:United States / Q000453:epidemiology
keywords: Neoadjuvant therapy; Overall survival; Pancreatic cancer; Pancreatic ductal adenocarcinoma; Pancreaticoduodenectomy; Radiation therapy