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Adjuvant chemothera...
Adjuvant chemotherapy with or without radiotherapy for resected pancreatic cancer after multiagent neoadjuvant chemotherapy
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- Franklin, Oskar, 1985- (author)
- Umeå universitet,Kirurgi,Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, CO, Aurora, United States
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- Sugawara, Toshitaka (author)
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, CO, Aurora, United States; Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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- Ross, Richard Blake (author)
- Department of Radiation Oncology, University of Colorado School of Medicine, CO, Aurora, United States
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- Rodriguez Franco, Salvador (author)
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, CO, Aurora, United States
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- Colborn, Kathryn (author)
- Department of Biostatistics and Informatics, University of Colorado School of Medicine, CO, Aurora, United States; Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, CO, Aurora, United States
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- Karam, Sana (author)
- Department of Radiation Oncology, University of Colorado School of Medicine, CO, Aurora, United States
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- Schulick, Richard D. (author)
- Department of Surgery, University of Colorado, CO, Aurora, United States; University of Colorado Cancer Center, CO, Aurora, United States
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- Del Chiaro, Marco (author)
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, CO, Aurora, United States; University of Colorado Cancer Center, CO, Aurora, United States
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(creator_code:org_t)
- 2024
- 2024
- English.
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In: Annals of Surgical Oncology. - : Springer Nature. - 1068-9265 .- 1534-4681.
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Subject headings
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- Background: Adjuvant therapy is associated with improved pancreatic cancer survival after neoadjuvant chemotherapy and surgery. However, whether adjuvant treatment should include radiotherapy is unclear in this setting.Methods: This study queried the National Cancer Database for pancreatic adenocarcinoma patients who underwent curative resection after multiagent neoadjuvant chemotherapy between 2010 and 2019 and received adjuvant treatment. Adjuvant chemotherapy plus radiotherapy (external beam, 45–50.4 gray) was compared with adjuvant chemotherapy alone. Uni- and multivariable Cox regression was used to assess survival associations. Analyses were repeated in a propensity score-matched subgroup.Results: Of 1983 patients who received adjuvant treatment after multiagent neoadjuvant chemotherapy and resection, 1502 (75.7%) received adjuvant chemotherapy alone and 481 (24.3%) received concomitant adjuvant radiotherapy (chemoradiotherapy). The patients treated with adjuvant chemoradiotherapy were younger, were treated at non-academic facilities more often, and had higher rates of lymph node metastasis (ypN1-2), positive resection margins (R1), and lymphovascular invasion (LVI+). The median survival was shorter for the chemoradiotherapy-treated patients according to the unadjusted analysis (26.8 vs 33.2 months; p = 0.0017). After adjustment for confounders, chemoradiotherapy was associated with better outcomes in the multivariable model (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.61–0.93; p = 0.008). The association between chemoradiotherapy and improved outcomes was stronger for the patients with grade III tumors (HR, 0.53; 95% CI, 0.37–0.74) or LVI+ tumors (HR, 0.58; 95% CI, 0.44–0.75). In a subgroup of 396 propensity-matched patients, chemoradiotherapy was associated with a survival benefit only for the patients with LVI+ or grade III tumors.Conclusion: After multiagent neoadjuvant chemotherapy and resection for pancreatic cancer, additional adjuvant chemoradiotherapy versus adjuvant chemotherapy alone is associated with improved survival for patients with LVI+ or grade III tumors.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Keyword
- Adjuvant therapy
- Chemotherapy
- Neoadjuvant therapy
- Pancreatic cancer
- Radiotherapy
- Surgery
Publication and Content Type
- ref (subject category)
- art (subject category)
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