Abstract
BackgroundThe application of radiotherapy (RT) in pancreatic cancer remains controversial.AimThe aim of the study was to evaluate the efficacy of radiotherapy (neoadjuvant and adjuvant radiotherapy) for resectable I/II pancreatic cancer.MethodsFourteen thousand nine hundred seventy-seven patients with pancreatic cancer were identified from SEER database from 2004 to 2015. Multivariate analyses were performed to determine factors including RT on overall survival. Overall survival and overall mortality among the different groups were evaluated using the Kaplan-Meier method and Gray’s test.ResultsPatients were divided into groups according to whether they received radiotherapy or not. The median survival time of all 14,977 patients without RT was 20 months, neoadjuvant RT was 24 months and adjuvant RT was 23 months (p < 0.0001). Median survival time of 2089 stage I patients without RT was 56 months, significantly longer than those with RT regardless of neoadjuvant or adjuvant RT (no RT: 56 months vs adjuvant RT: 37 months vs neoadjuvant RT: 27 months, P = 0.0039). Median survival time of 12,888 stage II patients with neoadjuvant RT was 24 months, adjuvant RT 22 months, significantly prolonged than those without radiotherapy (neoadjuvant RT: 24 months vs adjuvant RT: 22 months vs no RT: 17 months, P<0.0001). Neoadjuvant RT (HR = 1.434, P = 0.023, 95% CI: 1.051–1.957) was independent risk factors for prognosis of stage I patients, and adjuvant RT (HR = 0.904, P < 0.001, 95% CI: 0.861–0.950) predicted better outcomes for prognosis of stage II patients by multivariate analysis. The risk of cancer-related death caused by neoadjuvant RT in stage I and no-RT in stage II patients were significantly higher.ConclusionsThe study identified a significant survival advantage for the use of adjuvant RT over surgery alone or neoadjuvant RT in treating stage II pancreatic cancer. RT was not associated with survival benifit in stage I patients.
Highlights
Pancreatic cancer (PC) is an extremely malignant tumor with poor outcomes
The results indicated chemoradiotherapy did not improve the survival compared with chemotherapy
In the GERCOR phase Moderately differentiated (II) study [11], 90 patients after R0 resection of pancreatic head cancer were randomly divided into four gemcitabine treatment cycles or two gemcitabine cycles followed by gemcitabine with concurrent radiation weekly(50.4Gy/28f), the results showed median diseasefree survival (DFS) was 12 months in the adjuvant chemoradiotherapy group and 11 months in the chemotherapy alone group
Summary
The 5-year survival is as low as 2– 9% [1,2,3]. Surgery remains the only curative treatment for PC. Patients with PC usually present late period and only 20% of them have a chance of undergoing surgery when diagnosed [6]. Even in resectable patients who received surgery treatment, the prognosis was not very satisfactory. Adjuvant treatment is recommended in resected pancreatic cancer with PT1–4/N0-1M0 who undergo an R0/R1 resection to reduce the recurrence rate. In the past decades, owing to the chemotherapy and radiotherapy (RT) technology development, for patients who can successfully receive surgical resection, the 5-year survival rate after adjuvant treatment accounts for 27% [7]. The application of radiotherapy (RT) in pancreatic cancer remains controversial
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