TY - JOUR
T1 - Adjuvant chemoradiation in pancreatic cancer
T2 - Impact of radiotherapy dose on survival
AU - Morganti, Alessio G.
AU - Cellini, Francesco
AU - Buwenge, Milly
AU - Arcelli, Alessandra
AU - Alfieri, Sergio
AU - Calvo, Felipe A.
AU - Casadei, Riccardo
AU - Cilla, Savino
AU - Deodato, Francesco
AU - Di Gioia, Giancarmine
AU - Di Marco, Mariacristina
AU - Fuccio, Lorenzo
AU - Bertini, Federica
AU - Guido, Alessandra
AU - Herman, Joseph M.
AU - Macchia, Gabriella
AU - Maidment, Bert W.
AU - Miller, Robert C.
AU - Minni, Francesco
AU - Passoni, Paolo
AU - Valentini, Chiara
AU - Re, Alessia
AU - Regine, William F.
AU - Reni, Michele
AU - Falconi, Massimo
AU - Valentini, Vincenzo
AU - Mattiucci, Gian Carlo
N1 - Publisher Copyright:
© 2019 The Author(s).
PY - 2019/6/11
Y1 - 2019/6/11
N2 - Background: To evaluate the impact of radiation dose on overall survival (OS) in patients treated with adjuvant chemoradiation (CRT) for pancreatic ductal adenocarcinoma (PDAC). Methods: A multicenter retrospective analysis on 514 patients with PDAC (T1-4; N0-1; M0) treated with surgical resection with macroscopically negative margins (R0-1) followed by adjuvant CRT was performed. Patients were stratified into 4 groups based on radiotherapy doses (group 1: < 45 Gy, group 2: ≥ 45 and < 50 Gy, group 3: ≥ 50 and < 55 Gy, group 4: ≥ 55 Gy). Adjuvant chemotherapy was prescribed to 141 patients. Survival functions were plotted using the Kaplan-Meier method and compared through the log-rank test. Results: Median follow-up was 35 months (range: 3-120 months). At univariate analysis, a worse OS was recorded in patients with higher preoperative Ca 19.9 levels (≥ 90 U/ml; p < 0.001), higher tumor grade (G3-4, p = 0.004), R1 resection (p = 0.004), higher pT stage (pT3-4, p = 0.002) and positive nodes (p < 0.001). Furthermore, patients receiving increasing doses of CRT showed a significantly improved OS. In groups 1, 2, 3, and 4, median OS was 13.0 months, 21.0 months, 22.0 months, and 28.0 months, respectively (p = 0.004). The significant impact of higher dose was confirmed by multivariate analysis. Conclusions: Increasing doses of CRT seems to favorably impact on OS in adjuvant setting. The conflicting results of randomized trials on adjuvant CRT in PDAC could be due to < 45 Gy dose generally used.
AB - Background: To evaluate the impact of radiation dose on overall survival (OS) in patients treated with adjuvant chemoradiation (CRT) for pancreatic ductal adenocarcinoma (PDAC). Methods: A multicenter retrospective analysis on 514 patients with PDAC (T1-4; N0-1; M0) treated with surgical resection with macroscopically negative margins (R0-1) followed by adjuvant CRT was performed. Patients were stratified into 4 groups based on radiotherapy doses (group 1: < 45 Gy, group 2: ≥ 45 and < 50 Gy, group 3: ≥ 50 and < 55 Gy, group 4: ≥ 55 Gy). Adjuvant chemotherapy was prescribed to 141 patients. Survival functions were plotted using the Kaplan-Meier method and compared through the log-rank test. Results: Median follow-up was 35 months (range: 3-120 months). At univariate analysis, a worse OS was recorded in patients with higher preoperative Ca 19.9 levels (≥ 90 U/ml; p < 0.001), higher tumor grade (G3-4, p = 0.004), R1 resection (p = 0.004), higher pT stage (pT3-4, p = 0.002) and positive nodes (p < 0.001). Furthermore, patients receiving increasing doses of CRT showed a significantly improved OS. In groups 1, 2, 3, and 4, median OS was 13.0 months, 21.0 months, 22.0 months, and 28.0 months, respectively (p = 0.004). The significant impact of higher dose was confirmed by multivariate analysis. Conclusions: Increasing doses of CRT seems to favorably impact on OS in adjuvant setting. The conflicting results of randomized trials on adjuvant CRT in PDAC could be due to < 45 Gy dose generally used.
KW - Adjuvant
KW - Dose effect
KW - Pancreatic neoplasm
KW - Radiotherapy
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U2 - 10.1186/s12885-019-5790-2
DO - 10.1186/s12885-019-5790-2
M3 - Article
C2 - 31185957
AN - SCOPUS:85067096632
SN - 1471-2407
VL - 19
JO - BMC cancer
JF - BMC cancer
IS - 1
M1 - 569
ER -