Multi-institutional Pooled Analysis on Adjuvant Chemoradiation in Pancreatic Cancer

作者：Morganti Alessio G; Falconi Massimo; van Stiphout Ruud G P M; Mattiucci Gian Carlo^*; Alfieri Sergio; Calvo Felipe A; Dubois Jean Bernard; Fastner Gerd; Herman Joseph M; Maidment Bert W III; Miller Robert C; Regine William F; Reni Michele; Sharma Navesh K; Ippolito Edy; Valentini Vincenzo

来源：International Journal of Radiation Oncology, Biology, Physics, 2014, 90(4): 911-917.

DOI：10.1016/j.ijrobp.2014.07.024

Purpose: To determine the impact of chemoradiation therapy (CRT) on overall survival (OS) after resection of pancreatic adenocarcinoma. %26lt;br%26gt;Methods and Materials: A multicenter retrospective review of 955 consecutive patients who underwent complete resection with macroscopically negative margins (R0-1) for invasive carcinoma (T1-4; N0-1; M0) of the pancreas was performed. Exclusion criteria included metastatic or unresectable disease at surgery, macroscopic residual disease (R2), treatment with intraoperative radiation therapy (IORT), and a histological diagnosis of no ductal carcinoma, or postoperative death (within 60 days of surgery). In all, 623 patients received postoperative radiation therapy (RT), 575 patients received concurrent chemotherapy (CT), and 462 patients received adjuvant CT. %26lt;br%26gt;Results: Median follow-up was 21.0 months. Median OS after adjuvant CRT was 39.9 versus 24.8 months after no adjuvant CRT (P %26lt; .001) and 27.8 months after CT alone (P %26lt; .001). Five-year OS was 41.2% versus 24.8% with and without postoperative CRT, respectively. The positive impact of CRT was confirmed by multivariate analysis (hazard ratio [HR] = 0.72; confidence interval [ CI], 0.60-0.87; P = .001). Adverse prognostic factors identified by multivariate analysis included the following: R1 resection (HR = 1.17; CI = 1.07-1.28; P %26lt; .001), higher pT stage (HR = 1.23; CI = 1.11-1.37; P %26lt; .001), positive lymph nodes (HR = 1.27; CI = 1.15-1.41; P %26lt; .001), and tumor diameter %26gt;20 mm (HR = 1.14; CI = 1.05-1.23; P = .002). Multivariate analysis also showed a better prognosis in patients treated in centers with %26gt;10 pancreatic resections per year (HR = 0.87; CI = 0.78-0.97; P = .014) %26lt;br%26gt;Conclusion: This study represents the largest comparative study on adjuvant therapy in patients after resection of carcinoma of the pancreas. Overall survival was better in patients who received adjuvant CRT.

• 出版日期2014-11-15