Adjuvant chemoradiation in pancreatic cancer: Impact of radiotherapy dose on survival

Alessio G. Morganti, Francesco Cellini, Milly Buwenge, Alessandra Arcelli, Sergio Alfieri, Felipe A. Calvo, Riccardo Casadei, Savino Cilla, Francesco Deodato, Giancarmine Di Gioia, Mariacristina Di Marco, Lorenzo Fuccio, Federica Bertini, Alessandra Guido, Joseph M. Herman, Gabriella Macchia, Bert W. Maidment, Robert C. Miller, Francesco Minni, Paolo PassoniChiara Valentini, Alessia Re, William F. Regine, Michele Reni, Massimo Falconi, Vincenzo Valentini, Gian Carlo Mattiucci

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

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.

Original languageEnglish (US)
Article number569
JournalBMC cancer
Volume19
Issue number1
DOIs
StatePublished - Jun 11 2019

Keywords

  • Adjuvant
  • Dose effect
  • Pancreatic neoplasm
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Genetics
  • Cancer Research

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