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

Autor: Gian Carlo Mattiucci, Alessio G. Morganti, Lorenzo Fuccio, Michele Reni, Alessia Re, Felipe A. Calvo, Alessandra Arcelli, Francesco Cellini, Sergio Alfieri, Robert C. Miller, William F. Regine, Massimo Falconi, Vincenzo Valentini, Giancarmine Di Gioia, F. Bertini, Chiara Valentini, Joseph M. Herman, Riccardo Casadei, Milly Buwenge, Francesco Minni, Paolo Passoni, Mariacristina Di Marco, Savino Cilla, Francesco Deodato, Bert W. Maidment, Gabriella Macchia, Alessandra Guido
Přispěvatelé: Morganti A.G., Cellini F., Buwenge M., Arcelli A., Alfieri S., Calvo F.A., Casadei R., Cilla S., Deodato F., Di Gioia G., Di Marco M., Fuccio L., Bertini F., Guido A., Herman J.M., Macchia G., Maidment B.W., Miller R.C., Minni F., Passoni P., Valentini C., Re A., Regine W.F., Reni M., Falconi M., Valentini V., Mattiucci G.C., Morganti, A. G., Cellini, F., Buwenge, M., Arcelli, A., Alfieri, S., Calvo, F. A., Casadei, R., Cilla, S., Deodato, F., Di Gioia, G., Di Marco, M., Fuccio, L., Bertini, F., Guido, A., Herman, J. M., Macchia, G., Maidment, B. W., Miller, R. C., Minni, F., Passoni, P., Valentini, C., Re, A., Regine, W. F., Reni, M., Falconi, M., Valentini, V., Mattiucci, G. C.
Rok vydání: 2019
Předmět:
Male
0301 basic medicine
Cancer Research
medicine.medical_treatment
Kaplan-Meier Estimate
Gastroenterology
law.invention
0302 clinical medicine
Randomized controlled trial
law
Surgical oncology
80 and over
Stage (cooking)
Pancreatic neoplasm
Adjuvant
Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA
Aged
80 and over
Univariate analysis
Radiation
Radiotherapy Dosage
Chemoradiotherapy
Middle Aged
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Tumor Burden
Treatment Outcome
Oncology
Pancreatic Ductal
030220 oncology & carcinogenesis
Female
Dose effect
Research Article
Carcinoma
Pancreatic Ductal
Adult
medicine.medical_specialty
CA-19-9 Antigen
lcsh:RC254-282
Dose-Response Relationship
03 medical and health sciences
Radiotherapy
Aged
Chemoradiotherapy
Adjuvant
Dose-Response Relationship
Radiation
Follow-Up Studies
Humans
Lymph Nodes
Multivariate Analysis
Neoplasm Grading
Pancreatic Neoplasms
Retrospective Studies
Pancreatic cancer
Internal medicine
Genetics
medicine
business.industry
Carcinoma
Retrospective cohort study
medicine.disease
Radiation therapy
030104 developmental biology
business
Zdroj: BMC Cancer
BMC Cancer, Vol 19, Iss 1, Pp 1-10 (2019)
ISSN: 1471-2407
DOI: 10.1186/s12885-019-5790-2
Popis: 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.
Databáze: OpenAIRE
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