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Journal of Gastrointestinal Cancer

Erschienen in:

25.06.2019 | Original Research

Patterns of Care and Outcomes of Adjuvant Chemoradiation for Node-Positive Pancreatic Adenocarcinoma

verfasst von: Nikita Malakhov, Anna Lee, Ashley Albert, Ariel Lederman, John Byun, Joseph Safdieh, David Schreiber

Erschienen in: Journal of Gastrointestinal Cancer | Ausgabe 2/2020

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Abstract

Purpose

The literature has been conflicting on the superiority of adjuvant chemoradiation over chemotherapy for node-positive adenocarcinoma of the pancreas following definitive surgery. We aimed to evaluate the patterns of care and outcomes of these two treatment options using the National Cancer Database (NCDB).

Methods

Patients diagnosed with non-metastatic, node-positive adenocarcinoma of the pancreas from 2006 to 2014 who received oncologic resection with negative margins were identified in the NCDB. Patient- and clinical-related factors were compared between those who received adjuvant chemotherapy alone (aC) versus adjuvant chemoradiation (aCRT). Univariable and multivariable logistic regression was performed to assess for predictors of adjuvant chemoradiation use. The Kaplan-Meier method was used to assess overall survival (OS) and Cox regression analysis was used to assess impact of covariables on OS.

Results

There were 3609 patients who met the study criteria, of which 2988 (82.8%) received chemotherapy alone and 621 (17.2%) who received chemoradiation. Median follow up for living patients was 33.8 months (IQR 22–51). On multivariable logistic regression, those who received treatment in more recent years of diagnoses (OR 0.21–0.37, p < 0.001) were less likely to receive aCRT over aC. Two-year OS for those who received chemo alone was 44.9% and for chemoradiation was 42.6% (p = 0.169). This finding was sustained on multivariable survival analysis (HR 0.99, p = 0.867).

Conclusions

Adjuvant chemotherapy alone for adenocarcinoma of the pancreas is the predominant treatment of choice among US hospitals. There was no overall survival benefit noted in those who were treated with adjuvant chemoradiation.

Nur mit Berechtigung zugänglich

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34. https://doi.org/10.3322/caac.21551.CrossRefPubMed

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30. https://doi.org/10.3322/caac.21442.CrossRefPubMed

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67(1):7–30. https://doi.org/10.3322/caac.21387.CrossRefPubMed

Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. Jama. 2013;310(14):1473–81. https://doi.org/10.1001/jama.2013.279201.CrossRefPubMed

Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004;350(12):1200–10. https://doi.org/10.1056/NEJMoa032295.CrossRefPubMed

Neoptolemos JP, Stocken DD, Bassi C, Ghaneh P, Cunningham D, Goldstein D, et al. Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. Jama. 2010;304(10):1073–81. https://doi.org/10.1001/jama.2010.1275.CrossRefPubMed

Neoptolemos JP, Palmer DH, Ghaneh P, Psarelli EE, Valle JW, Halloran CM, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet (London, England). 2017;389(10073):1011–24. https://doi.org/10.1016/s0140-6736(16)32409-6.CrossRef

Neoptolemos JP, Dunn JA, Stocken DD, Almond J, Link K, Beger H, et al. Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet (London, England). 2001;358(9293):1576–85.CrossRef

Conroy T, Hammel P, Hebbar M, Ben Abdelghani M, Wei AC, Raoul JL, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med. 2018;379(25):2395–406. https://doi.org/10.1056/NEJMoa1809775.CrossRefPubMed

10.

Kalser MH, Ellenberg SS. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg. 1985;120(8):899–903.CrossRefPubMed

11.

Gastrointestinal Tumor Study Group. Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Cancer. 1987;59(12):2006–10.CrossRef

12.

Klinkenbijl JH, Jeekel J, Sahmoud T, van Pel R, Couvreur ML, Veenhof CH, et al. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg. 1999;230(6):776–82; discussion 782-774.CrossRefPubMedPubMedCentral

13.

Khorana AA, Mangu PB, Berlin J, Engebretson A, Hong TS, Maitra A, et al. Potentially curable pancreatic cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016;34(21):2541–56. https://doi.org/10.1200/jco.2016.67.5553.CrossRefPubMed

14.

Ducreux M, Cuhna AS, Caramella C, Hollebecque A, Burtin P, Goere D, et al. Cancer of the pancreas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(Suppl 5):v56–68. https://doi.org/10.1093/annonc/mdv295.CrossRefPubMed

15.

Network NCC (2018) Pancreatic adenocarcinoma (Version 1.2019). https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. Accessed March 15 2019.

16.

Park HS, Gross CP, Makarov DV, Yu JB. Immortal time bias: a frequently unrecognized threat to validity in the evaluation of postoperative radiotherapy. Int J Radiat Oncol Biol Phys. 2012;83(5):1365–73. https://doi.org/10.1016/j.ijrobp.2011.10.025.CrossRefPubMed

17.

Garofalo MC, Regine WF, Tan MT. On statistical reanalysis, the EORTC trial is a positive trial for adjuvant chemoradiation in pancreatic cancer. Ann Surg. 2006;244(2):332–3; author reply 333. https://doi.org/10.1097/01.sla.0000229980.81505.44.CrossRefPubMedPubMedCentral

18.

Garofalo M, Flannery T, Regine W. The case for adjuvant chemoradiation for pancreatic cancer. Best Pract Res Clin Gastroenterol. 2006;20(2):403–16. https://doi.org/10.1016/j.bpg.2005.11.001.CrossRefPubMed

19.

Koshy MC, Landry JC, Cavanaugh SX, Fuller CD, Willett CG, Abrams RA, et al. A challenge to the therapeutic nihilism of ESPAC-1. Int J Radiat Oncol Biol Phys. 2005;61(4):965–6. https://doi.org/10.1016/j.ijrobp.2004.11.018.CrossRefPubMed

20.

Rutter CE, Park HS, Corso CD, Lester-Coll NH, Mancini BR, Yeboa DN, et al. Addition of radiotherapy to adjuvant chemotherapy is associated with improved overall survival in resected pancreatic adenocarcinoma: an analysis of the National Cancer Data Base. Cancer. 2015;121(23):4141–9. https://doi.org/10.1002/cncr.29652.CrossRefPubMed

21.

Ma SJ, Hermann GM, Prezzano KM, Serra LM, Iovoli AJ, Singh AK. Adjuvant chemotherapy followed by concurrent chemoradiation is associated with improved survival for resected stage I-II pancreatic cancer. Cancer Med. 2019;8(3):939–52. https://doi.org/10.1002/cam4.1967.CrossRefPubMedPubMedCentral

22.

Krishnan M, Ahmed A, Walters RW, Silberstein PT. Factors affecting adjuvant therapy in stage III pancreatic cancer-analysis of the National Cancer Database. Clin Med Insights Oncol. 2017;11:1179554917728040. https://doi.org/10.1177/1179554917728040.CrossRefPubMedPubMedCentral

23.

Kooby DA, Gillespie TW, Liu Y, Byrd-Sellers J, Landry J, Bian J, et al. Impact of adjuvant radiotherapy on survival after pancreatic cancer resection: an appraisal of data from the national cancer data base. Ann Surg Oncol. 2013;20(11):3634–42. https://doi.org/10.1245/s10434-013-3047-x.CrossRefPubMedPubMedCentral

24.

Suss NR, Talamonti MS, Bryan DS, Wang CH, Kuchta KM, Stocker SJ, et al. Does adjuvant radiation provide any survival benefit after an R1 resections for pancreatic cancer? Surgery. 2018;163(5):1047–52. https://doi.org/10.1016/j.surg.2017.09.022.CrossRefPubMed

25.

Hsu CC, Herman JM, Corsini MM, Winter JM, Callister MD, Haddock MG, et al. Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study. Ann Surg Oncol. 2010;17(4):981–90. https://doi.org/10.1245/s10434-009-0743-7.CrossRefPubMedPubMedCentral

26.

Osipov A, Naziri J, Hendifar A, Dhall D, Rutgers JK, Chopra S, et al. Impact of margin status and lymphadenectomy on clinical outcomes in resected pancreatic adenocarcinoma: implications for adjuvant radiotherapy. J Gastrointest Oncol. 2016;7(2):239–47. https://doi.org/10.3978/j.issn.2078-6891.2015.109.CrossRefPubMedPubMedCentral

27.

Herman JM, Swartz MJ, Hsu CC, Winter J, Pawlik TM, Sugar E, et al. Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas: results of a large, prospectively collected database at the Johns Hopkins Hospital. J Clin Oncol. 2008;26(21):3503–10. https://doi.org/10.1200/jco.2007.15.8469.CrossRefPubMed

28.

Stocken DD, Buchler MW, Dervenis C, Bassi C, Jeekel H, Klinkenbijl JH, et al. Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer. Br J Cancer. 2005;92(8):1372–81. https://doi.org/10.1038/sj.bjc.6602513.CrossRefPubMedPubMedCentral

29.

Liao WC, Chien KL, Lin YL, Wu MS, Lin JT, Wang HP, et al. Adjuvant treatments for resected pancreatic adenocarcinoma: a systematic review and network meta-analysis. Lancet Oncol. 2013;14(11):1095–103. https://doi.org/10.1016/s1470-2045(13)70388-7.CrossRefPubMed

Titel: Patterns of Care and Outcomes of Adjuvant Chemoradiation for Node-Positive Pancreatic Adenocarcinoma
verfasst von: Nikita Malakhov
Anna Lee
Ashley Albert
Ariel Lederman
John Byun
Joseph Safdieh
David Schreiber
Publikationsdatum: 25.06.2019
Verlag: Springer US
Erschienen in: Journal of Gastrointestinal Cancer / Ausgabe 2/2020
Print ISSN: 1941-6628
Elektronische ISSN: 1941-6636
DOI: https://doi.org/10.1007/s12029-019-00265-2

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Patterns of Care and Outcomes of Adjuvant Chemoradiation for Node-Positive Pancreatic Adenocarcinoma