Alessio G Morganti1, Massimo Falconi2, Ruud G P M van Stiphout3, Gian-Carlo Mattiucci4, Sergio Alfieri5, Felipe A Calvo6, Jean-Bernard Dubois7, Gerd Fastner8, Joseph M Herman9, Bert W Maidment10, Robert C Miller11, William F Regine12, Michele Reni13, Navesh K Sharma12, Edy Ippolito14, Vincenzo Valentini15. 1. Department of Radiotherapy, Università Cattolica S. Cuore, Rome, Italy; Unit of Radiotherapy, Unit of General Oncology, Fondazione Giovanni Paolo II, Campobasso, Italy. 2. Department of Surgery, University of Verona, Verona, Italy. 3. Department of Radiation Oncology (MAASTRO), GROW, University Medical Centre Maastricht, The Netherlands. 4. Department of Radiotherapy, Università Cattolica S. Cuore, Rome, Italy. Electronic address: gcmattiucci@rm.unicatt.it. 5. Department of Surgery, Università Cattolica S. Cuore, Rome, Italy. 6. Department of Oncology, Hospital General Universitario Gregorio Marañón, Complutense University, Madrid, Spain. 7. Département de Radiothérapie, CRLC, Montpellier Cedex, France. 8. Department of Radiotherapy, PMU, Salzburg, Austria. 9. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland. 10. Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia. 11. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. 12. Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland. 13. Department of Oncology, S. Raffaele Scientific Institute, Milan, Italy. 14. Department of Radiation Oncology, University Campus Biomedico, Roma, Italy. 15. Department of Radiotherapy, Università Cattolica S. Cuore, Rome, Italy.
Abstract
PURPOSE: To determine the impact of chemoradiation therapy (CRT) on overall survival (OS) after resection of pancreatic adenocarcinoma. 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. 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<.001) and 27.8 months after CT alone (P<.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<.001), higher pT stage (HR = 1.23; CI = 1.11-1.37; P<.001), positive lymph nodes (HR = 1.27; CI = 1.15-1.41; P<.001), and tumor diameter >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 >10 pancreatic resections per year (HR = 0.87; CI = 0.78-0.97; P=.014) 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.
PURPOSE: To determine the impact of chemoradiation therapy (CRT) on overall survival (OS) after resection of pancreatic adenocarcinoma. 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. 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<.001) and 27.8 months after CT alone (P<.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<.001), higher pT stage (HR = 1.23; CI = 1.11-1.37; P<.001), positive lymph nodes (HR = 1.27; CI = 1.15-1.41; P<.001), and tumor diameter >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 >10 pancreatic resections per year (HR = 0.87; CI = 0.78-0.97; P=.014) 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.
Authors: Caitlin A McIntyre; Constantinos P Zambirinis; Alessandra Pulvirenti; Joanne F Chou; Mithat Gonen; Vinod P Balachandran; T Peter Kingham; Michael I D'Angelica; Murray F Brennan; Jeffrey A Drebin; William R Jarnagin; Peter J Allen Journal: Ann Surg Oncol Date: 2020-05-25 Impact factor: 5.344
Authors: Sebastian Bachmayer; Gerd Fastner; Andrea Vaszi; Wolfgang Iglseder; Peter Kopp; Josef Holzinger; Adam Dinnewitzer; Gabriel Rinnerthaler; Simon Peter Gampenrieder; Klaus Emmanuel; Richard Greil; Felix Sedlmayer; Franz Zehentmayr Journal: Strahlenther Onkol Date: 2018-03-01 Impact factor: 3.621
Authors: Gian Carlo Mattiucci; Alessio G Morganti; Francesco Cellini; Milly Buwenge; Riccardo Casadei; Andrea Farioli; Sergio Alfieri; Alessandra Arcelli; Federica Bertini; Felipe A Calvo; Silvia Cammelli; Lorenzo Fuccio; Lucia Giaccherini; Alessandra Guido; Joseph M Herman; Gabriella Macchia; Bert W Maidment; Robert C Miller; Francesco Minni; William F Regine; Michele Reni; Stefano Partelli; Massimo Falconi; Vincenzo Valentini Journal: Transl Oncol Date: 2018-09-17 Impact factor: 4.243