Kerri A Ohman1, Jingxia Liu2, David C Linehan3, Marcus C Tan4, Benjamin R Tan5, Ryan C Fields6, Steven M Strasberg6, William G Hawkins7. 1. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA. 2. Division of Public Health Sciences, Section of Oncologic Biostatistics, Washington University School of Medicine, St. Louis, MO, USA. 3. Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA. 4. Department of Surgery, University of South Alabama Health System, Mobile, AL, USA. 5. Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA. 6. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA; Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine, St. Louis, MO, USA. 7. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA; Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine, St. Louis, MO, USA. Electronic address: hawkinsw@wudosis.wustl.edu.
Abstract
To report long-term follow up of a phase II, single-arm trial of resectable pancreatic ductal adenocarcinoma (PDAC) treated with adjuvant interferon-based chemoradiation followed by gemcitabine to determine survival, recurrence, and complications. METHODS: From 2002 to 2005, 53 patients with PDAC underwent pancreaticoduodenectomy and received adjuvant interferon-based chemoradiation consisting of external-beam irradiation and simultaneous 3-drug chemotherapy of continuous daily 5-fluorouracil infusion, weekly intravenous bolus cisplatin, and subcutaneous interferon-α, followed by two months of weekly intravenous gemcitabine. RESULTS: Actual overall survival for the 5- and 10-year periods were 26% and 10%, respectively, with a median overall survival of 25 months (95% CI: 16.4-38.5). Adverse prognostic factors on multivariate analysis were positive tumor margin (p < 0.035), lymphovascular invasion (p < 0.015), and perineural invasion (p < 0.026). Median time to recurrence was 11 months. Positive tumor margin was associated with lymph node involvement (p < 0.005), portal vein resection (p < 0.038), and metastases (p < 0.018). Late complications were frequent and predominated by gastrointestinal and infectious complications. CONCLUSIONS: Adjuvant interferon-based chemoradiation for PDAC improves long-term survival compared to standard therapy. However, recurrence rates and long-term complications remain high, thus further studies are indicated to assess patient characteristics that indicate a favorable treatment profile.
To report long-term follow up of a phase II, single-arm trial of resectable pancreatic ductal adenocarcinoma (PDAC) treated with adjuvant interferon-based chemoradiation followed by gemcitabine to determine survival, recurrence, and complications. METHODS: From 2002 to 2005, 53 patients with PDAC underwent pancreaticoduodenectomy and received adjuvant interferon-based chemoradiation consisting of external-beam irradiation and simultaneous 3-drug chemotherapy of continuous daily 5-fluorouracil infusion, weekly intravenous bolus cisplatin, and subcutaneous interferon-α, followed by two months of weekly intravenous gemcitabine. RESULTS: Actual overall survival for the 5- and 10-year periods were 26% and 10%, respectively, with a median overall survival of 25 months (95% CI: 16.4-38.5). Adverse prognostic factors on multivariate analysis were positive tumor margin (p < 0.035), lymphovascular invasion (p < 0.015), and perineural invasion (p < 0.026). Median time to recurrence was 11 months. Positive tumor margin was associated with lymph node involvement (p < 0.005), portal vein resection (p < 0.038), and metastases (p < 0.018). Late complications were frequent and predominated by gastrointestinal and infectious complications. CONCLUSIONS: Adjuvant interferon-based chemoradiation for PDAC improves long-term survival compared to standard therapy. However, recurrence rates and long-term complications remain high, thus further studies are indicated to assess patient characteristics that indicate a favorable treatment profile.
Authors: V J Picozzi; R A Abrams; P A Decker; W Traverso; E M O'Reilly; E Greeno; R C Martin; L S Wilfong; M L Rothenberg; M C Posner; P W T Pisters Journal: Ann Oncol Date: 2010-07-29 Impact factor: 32.976
Authors: J H Klinkenbijl; J Jeekel; T Sahmoud; R van Pel; M L Couvreur; C H Veenhof; J P Arnaud; D G Gonzalez; L T de Wit; A Hennipman; J Wils Journal: Ann Surg Date: 1999-12 Impact factor: 12.969
Authors: Matthew H G Katz; Robert Wolff; Christopher H Crane; Gauri Varadhachary; Milind Javle; E Lin; Douglas B Evans; Jeffrey E Lee; Jason B Fleming; Peter W T Pisters Journal: Ann Surg Oncol Date: 2011-06-24 Impact factor: 5.344
Authors: Cristina R Ferrone; Michael W Kattan; James S Tomlinson; Sarah P Thayer; Murray F Brennan; Andrew L Warshaw Journal: J Clin Oncol Date: 2005-10-20 Impact factor: 44.544
Authors: Jennifer L Gnerlich; Samuel R Luka; Anjali D Deshpande; Bernard J Dubray; Joshua S Weir; Danielle H Carpenter; Elizabeth M Brunt; Steven M Strasberg; William G Hawkins; David C Linehan Journal: Arch Surg Date: 2012-08
Authors: David C Linehan; Marcus C B Tan; Steven M Strasberg; Jeffrey A Drebin; William G Hawkins; Joel Picus; Robert J Myerson; Robert S Malyapa; Michael Hull; Kathryn Trinkaus; Benjamin R Tan Journal: Ann Surg Date: 2008-08 Impact factor: 12.969
Authors: V O Oria; P Bronsert; A R Thomsen; M C Föll; C Zamboglou; Luciana Hannibal; S Behringer; M L Biniossek; C Schreiber; A L Grosu; L Bolm; D Rades; T Keck; M Werner; U F Wellner; O Schilling Journal: Transl Oncol Date: 2018-08-30 Impact factor: 4.243