Abstract

BackgroundThe recommendation for postoperative chemotherapy in pancreatic ductal adenocarcinoma (PDAC) is based on prospective randomized trials. However, patients included in clinical trials do not often reflect the overall patient population treated in clinical practice.Materials and methodsA retrospective review of all patients undergoing pancreas resection for PDAC between 2001 and 2013 was performed. Follow-up data from oncologists, general practitioners, or hospital patient files were available for 92% of patients.ResultsA total of 251 patients were included in our analysis. Chemotherapy was recommended for 223 patients, but 86 patients did not follow the recommendation. The application of the recommended chemotherapy, consisting of 6 cycles of gemcitabine, was only applied to 45 patients. Forty patients received the recommended number of cycles with dose reduction or prolonged intervals between cycles, and adjuvant chemotherapy was terminated prior to the intended completion of all 6 cycles in 54 patients. Survival of patients after adjuvant chemotherapy was increased compared to that of patients without chemotherapy (with recurrence 25.6 vs. 14.3 months, p = 0.001, and without recurrence 27.4 vs. 14.3 months, p < 0.001). Terminating chemotherapy prior to completion (p = 0.009) as well as a lower number of chemotherapy cycles (p = 0.026) was associated with a decreased survival.ConclusionAdjuvant chemotherapy improves overall and disease-free survival after curative pancreatic resection, but only a small fraction of patients completes the recommended 6 cycles of adjuvant chemotherapy. Our data indicates that performance status of patients after pancreas resections for PDAC requires not only highly biologically active but also well-tolerated adjuvant chemotherapy regimens.

Highlights

  • Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive malignant neoplasms with a poor survival rate [1]

  • Our data indicates that performance status of patients after pancreas resections for pancreatic ductal adenocarcinoma (PDAC) requires highly biologically active and well-tolerated adjuvant chemotherapy regimens

  • We focused on the number of chemotherapy applications performed, reasons leading to an early termination of the adjuvant chemotherapy, and impact of the early termination of adjuvant chemotherapy on the survival of the patients

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Summary

Introduction

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive malignant neoplasms with a poor survival rate [1]. Chikhladze et al World Journal of Surgical Oncology (2019) 17:185 consequence, 30% of patients who are primarily eligible for adjuvant chemotherapy are never treated, mostly due to the presence of major comorbidities or due to postoperative complications after pancreas resection [7, 9, 10]. In patients with complication-free postoperative course, about 40% do not receive the complete treatment or require dose-reduction due to chemotherapy-related toxicity and adverse events [4, 11]. The aim of this singlecenter study was to evaluate the effect of adjuvant chemotherapy on long-term survival of patients after pancreatic resection for ductal adenocarcinoma. Patients included in clinical trials do not often reflect the overall patient population treated in clinical practice

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