Document Detail


Survival after chemoradiation in resected pancreatic cancer: the impact of adjuvant gemcitabine.
MedLine Citation:
PMID:  22420967     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To evaluate survival in patients with resected pancreatic cancer treated with concurrent chemoradiation with or without adjuvant gemcitabine (Gem).
METHODS AND MATERIALS: From 1998 to 2010, 86 patients with pancreatic adenocarcinoma who underwent resection were treated with adjuvant concurrent chemoradiation. Thirty-four patients received concurrent 5-fluorouracil-based chemoradiation (5-FU/RT) with traditional field radiation (range, 45-61.2 Gy; median, 50.4 Gy) without further adjuvant therapy. Thirty patients received traditional field 5-FU/RT (range, 45-60.4 Gy; median, 50.4 Gy) with Gem (1,000 mg/m(2) weekly) either before and after radiotherapy or only after radiotherapy. Twenty-two patients received concurrent full-dose Gem (1,000 mg/m(2) weekly)-based chemoradiation (Gem/RT), consisting of involved-field radiation (range, 27-38 Gy; median, 36 Gy) followed by further adjuvant Gem.
RESULTS: The median age of the cohort was 65 years (range, 40-80 years). Of the patients, 58 had T3 tumors (67%), 22 had T2 tumors (26%), and 6 had T1 tumors (7%). N1 disease was present in 61 patients (71%), whereas 18 patients (21%) had R1 resections. Performance status, lymph node status, and margin status were all similar among the treatment groups. Median follow-up was 19.0 months. Median overall survival (OS) (19.2 months, 19.0 months, and 21.0 months) and 3-year OS rates (26.5%, 27.2%, and 32.1%) were similar among patients with 5-FU/RT with no adjuvant Gem, those with 5-FU/RT with adjuvant Gem, and those with Gem/RT with adjuvant Gem, respectively (p = 0.88). Patients who received adjuvant Gem had a similar median OS (22.1 months) and 3-year OS rate (29%) compared to patients who did not (19.2 months and 26.5%, respectively) (p = 0.62). There was a trend for improved 3-year OS rates in patients with R0 vs. R1 resections (28.1% vs. 14.2%, p = 0.06) and in patients with T1 and T2 vs. T3 tumors (38% vs. 20%, p = 0.09). Node-negative patients had an improved 3-year OS rate (30.1%) when compared with patients with N1 disease (16.2%) (p = 0.02).
CONCLUSION: In our cohort of patients with resected pancreatic cancer, Gem chemotherapy did not improve OS after chemoradiotherapy.
Authors:
Andrew Baschnagel; Chirag Shah; Jeffrey Margolis; Laura Nadeau; Julie Stein; Robert Jury; John M Robertson
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Publication Detail:
Type:  Journal Article     Date:  2012-03-13
Journal Detail:
Title:  International journal of radiation oncology, biology, physics     Volume:  83     ISSN:  1879-355X     ISO Abbreviation:  Int. J. Radiat. Oncol. Biol. Phys.     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-05-28     Completed Date:  2012-07-30     Revised Date:  2013-06-03    
Medline Journal Info:
Nlm Unique ID:  7603616     Medline TA:  Int J Radiat Oncol Biol Phys     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e331-5     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Affiliation:
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan 48072, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Antimetabolites, Antineoplastic / therapeutic use
Chemoradiotherapy / mortality*
Chemotherapy, Adjuvant / methods,  mortality
Deoxycytidine / analogs & derivatives*,  therapeutic use
Drug Administration Schedule
Fluorouracil / therapeutic use
Follow-Up Studies
Humans
Middle Aged
Pancreatic Neoplasms / mortality*,  pathology,  therapy*
Radiation-Sensitizing Agents / therapeutic use*
Radiotherapy Dosage
Radiotherapy, Conformal / methods,  mortality
Survival Analysis
Chemical
Reg. No./Substance:
0/Antimetabolites, Antineoplastic; 0/Radiation-Sensitizing Agents; 51-21-8/Fluorouracil; 951-77-9/Deoxycytidine; B76N6SBZ8R/gemcitabine

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