Yen-Kuang Lin1, Mao-Chih Hsieh2, Chia-Lun Chang3, Jyh-Ming Chow3, Kevin Sheng-Po Yuan4, Alexander T H Wu5, Szu-Yuan Wu6. 1. Biostatistics Center and School of Public Health, Taipei Medical University, Taiwan. 2. Department of General Surgery, Wan Fang Hospital, Taipei Medical University, Taiwan. 3. Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University, Taiwan. 4. Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taiwan. 5. Ph.D. Program for Translational Medicine, Taipei Medical University, Taiwan. 6. Department of Radiation Oncology, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Institute of Clinical Science, Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: szuyuanwu5399@gmail.com.
Abstract
PURPOSE: In the era of intensity-modulation radiation therapy (IMRT), no prospective randomized trial has evaluated the efficacy of IMRT exclusively, such as concurrent chemoradiotherapy (CCRT), sequential induction chemotherapy followed by radiotherapy (CT-RT), and systemic chemotherapy (CT) alone, for treating unresectable pancreatic adenocarcinomas (PAs) without metastasis. Through propensity score matching, we designed a nationwide, population-based, head-to-head cohort study to determine the effects of various treatments on unresectable PAs. PATIENTS AND METHODS: We minimized the confounding effects of various treatment outcomes in patients with unresectable PAs from the Taiwan Cancer Registry database by dividing them as follows: group 1, CCRT; group 2, sequential CT-RT; group 3, nontreatment; and group 4, CT alone. RESULTS: The matching process yielded a final cohort of 2960 patients (740 patients each in groups 1, 2, 3, and 4). In both univariate and multivariate Cox regression analyses, the adjusted hazard ratios (95% confidence interval) derived for the definitive CCRT and sequential CT-RT groups compared with the CT alone group were 0.443 (0.397-0.495) and 0.633 (0.568-0.705), respectively. CONCLUSIONS: A combination of IMRT and systemic CT for the treatment of unresectable PAs might increase survival compared with CT alone.
PURPOSE: In the era of intensity-modulation radiation therapy (IMRT), no prospective randomized trial has evaluated the efficacy of IMRT exclusively, such as concurrent chemoradiotherapy (CCRT), sequential induction chemotherapy followed by radiotherapy (CT-RT), and systemic chemotherapy (CT) alone, for treating unresectable pancreatic adenocarcinomas (PAs) without metastasis. Through propensity score matching, we designed a nationwide, population-based, head-to-head cohort study to determine the effects of various treatments on unresectable PAs. PATIENTS AND METHODS: We minimized the confounding effects of various treatment outcomes in patients with unresectable PAs from the Taiwan Cancer Registry database by dividing them as follows: group 1, CCRT; group 2, sequential CT-RT; group 3, nontreatment; and group 4, CT alone. RESULTS: The matching process yielded a final cohort of 2960 patients (740 patients each in groups 1, 2, 3, and 4). In both univariate and multivariate Cox regression analyses, the adjusted hazard ratios (95% confidence interval) derived for the definitive CCRT and sequential CT-RT groups compared with the CT alone group were 0.443 (0.397-0.495) and 0.633 (0.568-0.705), respectively. CONCLUSIONS: A combination of IMRT and systemic CT for the treatment of unresectable PAs might increase survival compared with CT alone.