PURPOSE: To evaluate the efficacy of adjuvant chemoradiation therapy (CRT) for pancreatic adenocarcinoma patients ≥ 75 years of age. METHODS: The study group of 655 patients underwent pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma at the Johns Hopkins Hospital over a 12-year period (8/30/1993 to 2/28/2005). Demographic characteristics, comorbidities, intraoperative data, pathology data, and patient outcomes were collected and analyzed by adjuvant treatment status and age ≥ 75 years. Cox proportional hazards analysis determined clinical predictors of mortality and morbidity. RESULTS: We identified 166 of 655 (25.3%) patients were ≥ 75 years of age and 489 of 655 patients (74.7%) were <75 years of age. Forty-nine patients in the elderly group (29.5%) received adjuvant CRT. For elderly patients, node-positive metastases (p = 0.008), poor/anaplastic differentiation (p = 0.012), and undergoing a total pancreatectomy (p = 0.010) predicted poor survival. The 2-year survival for elderly patients receiving adjuvant therapy was improved compared with surgery alone (49.0% vs. 31.6%, p = 0.013); however, 5-year survival was similar (11.7% vs. 19.8%, respectively, p = 0.310). After adjusting for major confounders, adjuvant therapy in elderly patients had a protective effect with respect to 2-year survival (relative risk [RR] 0.58, p = 0.044), but not 5-year survival (RR 0.80, p = 0.258). Among the nonelderly, CRT was significantly associated with 2-year survival (RR 0.60, p < 0.001) and 5-year survival (RR 0.69, p < 0.001), after adjusting for confounders. CONCLUSIONS: Adjuvant therapy after PD is significantly associated with increased 2-year but not 5-year survival in elderly patients. Additional studies are needed to select which elderly patients are likely to benefit from adjuvant CRT.
PURPOSE: To evaluate the efficacy of adjuvant chemoradiation therapy (CRT) for pancreatic adenocarcinomapatients ≥ 75 years of age. METHODS: The study group of 655 patients underwent pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma at the Johns Hopkins Hospital over a 12-year period (8/30/1993 to 2/28/2005). Demographic characteristics, comorbidities, intraoperative data, pathology data, and patient outcomes were collected and analyzed by adjuvant treatment status and age ≥ 75 years. Cox proportional hazards analysis determined clinical predictors of mortality and morbidity. RESULTS: We identified 166 of 655 (25.3%) patients were ≥ 75 years of age and 489 of 655 patients (74.7%) were <75 years of age. Forty-nine patients in the elderly group (29.5%) received adjuvant CRT. For elderly patients, node-positive metastases (p = 0.008), poor/anaplastic differentiation (p = 0.012), and undergoing a total pancreatectomy (p = 0.010) predicted poor survival. The 2-year survival for elderly patients receiving adjuvant therapy was improved compared with surgery alone (49.0% vs. 31.6%, p = 0.013); however, 5-year survival was similar (11.7% vs. 19.8%, respectively, p = 0.310). After adjusting for major confounders, adjuvant therapy in elderly patients had a protective effect with respect to 2-year survival (relative risk [RR] 0.58, p = 0.044), but not 5-year survival (RR 0.80, p = 0.258). Among the nonelderly, CRT was significantly associated with 2-year survival (RR 0.60, p < 0.001) and 5-year survival (RR 0.69, p < 0.001), after adjusting for confounders. CONCLUSIONS: Adjuvant therapy after PD is significantly associated with increased 2-year but not 5-year survival in elderly patients. Additional studies are needed to select which elderly patients are likely to benefit from adjuvant CRT.
Authors: G Freyer; J-F Geay; S Touzet; J Provencal; B Weber; J-P Jacquin; G Ganem; N Tubiana-Mathieu; O Gisserot; E Pujade-Lauraine Journal: Ann Oncol Date: 2005-08-10 Impact factor: 32.976
Authors: Joseph M Herman; Michael J Swartz; Charles C Hsu; Jordan Winter; Timothy M Pawlik; Elizabeth Sugar; Ray Robinson; Daniel A Laheru; Elizabeth Jaffee; Ralph H Hruban; Kurtis A Campbell; Christopher L Wolfgang; Fariba Asrari; Ross Donehower; Manuel Hidalgo; Luis A Diaz; Charles Yeo; John L Cameron; Richard D Schulick; Ross Abrams Journal: J Clin Oncol Date: 2008-07-20 Impact factor: 44.544
Authors: Ching-Wei D Tzeng; Matthew H G Katz; Jason B Fleming; Jeffrey E Lee; Peter W T Pisters; Holly M Holmes; Gauri R Varadhachary; Robert A Wolff; James L Abbruzzese; Jean-Nicolas Vauthey; Thomas A Aloia Journal: J Gastrointest Surg Date: 2013-10-16 Impact factor: 3.452
Authors: Thomas J Hayman; Tobin Strom; Gregory M Springett; Lodovico Balducci; Sarah E Hoffe; Kenneth L Meredith; Pamela Hodul; Mokenge Malafa; Ravi Shridhar Journal: J Gastrointest Oncol Date: 2015-10
Authors: Brent T Xia; David A Habib; Vikrom K Dhar; Nick C Levinsky; Young Kim; Dennis J Hanseman; Jeffrey M Sutton; Gregory C Wilson; Milton Smith; Kyuran Ann Choe; Jeffrey J Sussman; Syed A Ahmad; Daniel E Abbott Journal: Ann Surg Oncol Date: 2016-07-26 Impact factor: 5.344
Authors: Jessica Frakes; Eric A Mellon; Gregory M Springett; Pamela Hodul; Mokenge P Malafa; William J Fulp; Xiuhua Zhao; Sarah E Hoffe; Ravi Shridhar; Kenneth L Meredith Journal: J Gastrointest Oncol Date: 2017-10
Authors: Hao Liu; Kamila Naxerova; Matthias Pinter; Joao Incio; Hang Lee; Kohei Shigeta; William W Ho; Jonathan A Crain; Alex Jacobson; Theodoros Michelakos; Daniella Dias-Santos; Andrea Zanconato; Theodore S Hong; Jeffrey W Clark; Janet E Murphy; David P Ryan; Vikram Deshpande; Keith D Lillemoe; Carlos Fernandez-Del Castillo; Michael Downes; Ronald M Evans; James Michaelson; Cristina R Ferrone; Yves Boucher; Rakesh K Jain Journal: Clin Cancer Res Date: 2017-06-09 Impact factor: 12.531
Authors: Amol K Narang; Robert C Miller; Charles C Hsu; Sumita Bhatia; Timothy M Pawlik; Dan Laheru; Ralph H Hruban; Jessica Zhou; Jordan M Winter; Michael G Haddock; John H Donohue; Richard D Schulick; Christopher L Wolfgang; John L Cameron; Joseph M Herman Journal: Radiat Oncol Date: 2011-09-28 Impact factor: 3.481
Authors: Carolyn H Kim; Diane C Ling; Rodney E Wegner; John C Flickinger; Dwight E Heron; Herbert Zeh; Arthur J Moser; Steven A Burton Journal: Radiat Oncol Date: 2013-10-16 Impact factor: 3.481