Chemoradiation After Pancreatic Cancer Surgery Adds Months to Survival
Last Updated: 2010-01-27 18:29:03 -0400 (Reuters Health)
And while outcomes were best at teaching hospitals or high-volume centers, the study results suggested that postoperative chemoradiotherapy yields a benefit at all types of centers.
Adjuvant chemoradiotherapy is a generally accepted treatment after pancreatic extirpation, the study investigators note in the January Archives of Surgery. The question remains, however, whether better outcomes with combined therapies is actually related to treatment in specialty centers.
Led by Dr. Leonidas G. Koniaris, researchers at the University of Miami Miller School of Medicine used the Florida Cancer Data System and other state databases to identify 2877 patients (mean age 67 years) who had curative-intent pancreatic resections between 1998 and 2002.
Overall, surgery alone was used in 52% of patients, postoperative chemoradiotherapy in 26%, preoperative/combined chemoradiotherapy in 2%, postoperative chemotherapy in 10%, and postop radiation in 4%. The treatment was unknown in 6% of patients.
In multivariate regression analysis adjusted for sociodemographic and cancer characteristics, postoperative chemoradiation was independently associated with a better median survival compared to surgery alone (17.0 vs 12.6 months; hazard ratio 0.69, p = 0.04).
The only other treatment variables significantly associated with outcome were therapy at high-volume centers (HR 0.85, p < 0.001) and at teaching hospitals (HR = 0.84, p < 0.001). Patients with the greatest survival benefit were treated with surgery and adjuvant chemoradiotherapy at a high-volume center or a teaching facility (median survival 20-22 months).
Neither neoadjuvant therapy nor postoperative chemotherapy had a survival benefit. There was a nonsignificant trend toward improved survival with postoperative radiation (HR 0.74, p = 0.08).
This study involved a large, multi-institutional cohort of all ages, comorbidities, races, ethnicities, and socioeconomic status. The researchers point out, however, that surgical margins, specific treatment regimens, and performance status could not be analyzed, which might have led to a selection bias.
Despite the retrospective nature of the study, they conclude, it "provides strong evidence in a real-world setting that postoperative chemoradiotherapy and possibly adjuvant radiotherapy alone improve clinical outcome in patients with pancreatic cancer," independent of treatment facility.
Still, the benefit remains modest, and Dr. Koniaris and his colleagues look forward to studying new biologic agents for pancreatic cancer.
Arch Surg 2010;145:49-56.
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