Abstract
ObjectiveStandard postoperative therapy for pancreatic cancer consists of both chemotherapy alone and chemoradiation. We sought to investigate whether the sequence of chemotherapy and chemoradiation and overall time to initiation of adjuvant therapy would impact local vs. distant recurrence.MethodsAfter Institutional Review Board approval, resected pancreas cancer patient charts were evaluated for medical background, surgical, pathological, chemoradiation (CRT), and follow-up. Local recurrence (LR) was defined as failures occurring in the postoperative bed and regional lymph nodes. Early vs. late CRT was defined by whether CRT was given early (within 1–2 cycles of adjuvant chemotherapy) or late in the course of adjuvant chemotherapy (after the 3rd cycle of chemotherapy). The postoperative interval variance was compared to LR factors such as progression-free survival (PFS) and overall survival (OS).ResultsOf the 34 eligible patients, 47% (n=16) underwent early CRT and 41% (n=14) underwent late CRT. 12% (n=14) did not undergo any induction chemotherapy. At median follow-up of 22 months, 53% (n=18) had metastases, 24% (n=8) had LR, and 24% (n=8) were disease free. Kaplan-Meier curves revealed that early vs. late CRT did not appear to significantly impact OS (p=0.63), PFS (p=0.085) or LR (p=0.19). Postoperative interval did not affect PFS (p=0.42) or OS (p=0.93).ConclusionsEarly vs. late CRT and the time to initiation of adjuvant therapy were not significantly associated with LR in patients with resected pancreatic cancer. Future prospective studies are required to determine if sequencing of chemotherapy, CRT, or the postoperative interval impact survival and patterns of recurrence.
Highlights
Pancreatic cancer is the fourth leading cause of cancer-related death in the United States, and roughly 20% of the patients diagnosed are able to undergo potentially curative surgical resection
Future prospective studies are required to determine if sequencing of chemotherapy, CRT, or the postoperative interval impact survival and patterns of recurrence
Baseline Patient Characteristics In total, 34 patients treated between July 2004 and October 2011 was eligible for this investigation
Summary
Pancreatic cancer is the fourth leading cause of cancer-related death in the United States, and roughly 20% of the patients diagnosed are able to undergo potentially curative surgical resection. Even among those with resected pancreatic cancer, the 5-year survival rate hovers under 20%, and drops to about 10% for those with even one positive lymph node [1,2]. The Gastrointestinal Tumor Study Group compared surgery alone to surgery followed by 5-fluorouracil (5-FU)-based CRT and maintenance 5-FU, which demonstrated an improvement in OS and lead to the adoption of CRT as the preferred immediate post-surgical treatment [5]. One cycle of chemotherapy, CRT, four cycles post-CRT was delivered [6]
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