Shane Lloyd1, Bryan W Chang. 1. Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.
Abstract
BACKGROUND: The optimal treatment strategy for locally advanced and borderline resectable pancreatic cancer is not known. We compared overall survival (OS), local control (LC), metastasis free survival (MFS), and percent of patients who were able to undergo successful surgical resection for three treatment strategies. METHODS: We retrospectively reviewed 115 sequentially treated cases of locally advanced (T4) or borderline resectable (T3 but unresectable) pancreatic cancer. Patients were treated with either chemotherapy alone (C), concurrent chemoradiation therapy (CRT), or chemotherapy followed by chemoradiation therapy (CCRT). We compared survival between groups using Kaplan-Meier analysis and Cox-proportional hazards models. RESULTS: Median follow-up was 18.7 months. Fifty-six (49%) patients had locally advanced disease. Of the patients who received chemotherapy up-front, 82/92 (89%) received gemcitabine-based chemotherapy. Of the patients receiving C alone, 11/65 (17%) were diagnosed with distant metastases or died before 3 months. The rate of successful surgical resection was 6/50 (12%) in patients treated with radiation therapy (CRT or CCRT). Median survival times for patients undergoing C, CRT, and CCRT were 13.9, 12.5, and 21.5 months respectively. Patients treated with CCRT experienced statistically significant improved OS and MFS compared to C alone (P=0.003 and P=0.012 respectively). There was no difference in LC between treatment groups. On multivariable analysis younger age (P=0.009), borderline resectable disease (P=0.035), successful surgery (P=0.002), and receiving chemotherapy followed by chemoradiation therapy (P=0.035) were all associated with improved OS. CONCLUSIONS: Treatment with CCRT is associated with improved median OS and MFS compared with C alone. This strategy may select for patients who are less likely to develop early metastases and therefore have a better prognosis.
BACKGROUND: The optimal treatment strategy for locally advanced and borderline resectable pancreatic cancer is not known. We compared overall survival (OS), local control (LC), metastasis free survival (MFS), and percent of patients who were able to undergo successful surgical resection for three treatment strategies. METHODS: We retrospectively reviewed 115 sequentially treated cases of locally advanced (T4) or borderline resectable (T3 but unresectable) pancreatic cancer. Patients were treated with either chemotherapy alone (C), concurrent chemoradiation therapy (CRT), or chemotherapy followed by chemoradiation therapy (CCRT). We compared survival between groups using Kaplan-Meier analysis and Cox-proportional hazards models. RESULTS: Median follow-up was 18.7 months. Fifty-six (49%) patients had locally advanced disease. Of the patients who received chemotherapy up-front, 82/92 (89%) received gemcitabine-based chemotherapy. Of the patients receiving C alone, 11/65 (17%) were diagnosed with distant metastases or died before 3 months. The rate of successful surgical resection was 6/50 (12%) in patients treated with radiation therapy (CRT or CCRT). Median survival times for patients undergoing C, CRT, and CCRT were 13.9, 12.5, and 21.5 months respectively. Patients treated with CCRT experienced statistically significant improved OS and MFS compared to C alone (P=0.003 and P=0.012 respectively). There was no difference in LC between treatment groups. On multivariable analysis younger age (P=0.009), borderline resectable disease (P=0.035), successful surgery (P=0.002), and receiving chemotherapy followed by chemoradiation therapy (P=0.035) were all associated with improved OS. CONCLUSIONS: Treatment with CCRT is associated with improved median OS and MFS compared with C alone. This strategy may select for patients who are less likely to develop early metastases and therefore have a better prognosis.
Authors: P Therasse; S G Arbuck; E A Eisenhauer; J Wanders; R S Kaplan; L Rubinstein; J Verweij; M Van Glabbeke; A T van Oosterom; M C Christian; S G Gwyther Journal: J Natl Cancer Inst Date: 2000-02-02 Impact factor: 13.506
Authors: Jordan M Winter; John L Cameron; Kurtis A Campbell; Meghan A Arnold; David C Chang; Joann Coleman; Mary B Hodgin; Patricia K Sauter; Ralph H Hruban; Taylor S Riall; Richard D Schulick; Michael A Choti; Keith D Lillemoe; Charles J Yeo Journal: J Gastrointest Surg Date: 2006-11 Impact factor: 3.452
Authors: Thierry Conroy; Françoise Desseigne; Marc Ychou; Olivier Bouché; Rosine Guimbaud; Yves Bécouarn; Antoine Adenis; Jean-Luc Raoul; Sophie Gourgou-Bourgade; Christelle de la Fouchardière; Jaafar Bennouna; Jean-Baptiste Bachet; Faiza Khemissa-Akouz; Denis Péré-Vergé; Catherine Delbaldo; Eric Assenat; Bruno Chauffert; Pierre Michel; Christine Montoto-Grillot; Michel Ducreux Journal: N Engl J Med Date: 2011-05-12 Impact factor: 91.245
Authors: T A Sohn; C J Yeo; J L Cameron; L Koniaris; S Kaushal; R A Abrams; P K Sauter; J Coleman; R H Hruban; K D Lillemoe Journal: J Gastrointest Surg Date: 2000 Nov-Dec Impact factor: 3.452
Authors: Girish Mishra; Jerome Butler; Coty Ho; Susan Melin; L Douglas Case; Peter R Ennever; Gustav C Magrinat; James D Bearden; Drew C Minotto; Russell Howerton; Edward Levine; A William Blackstock Journal: Am J Clin Oncol Date: 2005-08 Impact factor: 2.339
Authors: Christine A Iacobuzio-Donahue; Baojin Fu; Shinichi Yachida; Mingde Luo; Hisashi Abe; Clark M Henderson; Felip Vilardell; Zheng Wang; Jesse W Keller; Priya Banerjee; Joseph M Herman; John L Cameron; Charles J Yeo; Marc K Halushka; James R Eshleman; Marian Raben; Alison P Klein; Ralph H Hruban; Manuel Hidalgo; Daniel Laheru Journal: J Clin Oncol Date: 2009-03-09 Impact factor: 44.544
Authors: Sunil Krishnan; Vishal Rana; Nora A Janjan; Gauri R Varadhachary; James L Abbruzzese; Prajnan Das; Marc E Delclos; Morris S Gould; Douglas B Evans; Robert A Wolff; Christopher H Crane Journal: Cancer Date: 2007-07-01 Impact factor: 6.860
Authors: Jin He; Andrew J Page; Matthew Weiss; Christopher L Wolfgang; Joseph M Herman; Timothy M Pawlik Journal: World J Gastroenterol Date: 2014-03-07 Impact factor: 5.742
Authors: Gustavo Kohan; Carlos G Ocampo; Hugo I Zandalazini; Roberto Klappenbach; Federico Yazyi; Ornella Ditulio; Adelina Coturel; Carlos Canullán; Luis T Chiappetta Porras; Juan Alvarez Rodriguez Journal: Surg Endosc Date: 2014-10-11 Impact factor: 4.584
Authors: Bikram Shrestha; Yifei Sun; Farzana Faisal; Victoria Kim; Kevin Soares; Alex Blair; Joseph M Herman; Amol Narang; Avani S Dholakia; Lauren Rosati; Amy Hacker-Prietz; Linda Chen; Daniel A Laheru; Ana De Jesus-Acosta; Dung T Le; Ross Donehower; Nilofar Azad; Luis A Diaz; Adrian Murphy; Valerie Lee; Elliot K Fishman; Ralph H Hruban; Tingbo Liang; John L Cameron; Martin Makary; Matthew J Weiss; Nita Ahuja; Jin He; Christopher L Wolfgang; Chiung-Yu Huang; Lei Zheng Journal: Cancer Med Date: 2017-06-21 Impact factor: 4.452