Better Defining the Role of Total Neoadjuvant Radiation: Changing Paradigms in Locally Advanced Pancreatic Cancer

Background This study was designed to better define the role of radiation (Neo-Rad) in addition to neoadjuvant multiagent chemotherapy (NAT) for the treatment of locally advanced pancreatic cancer. Methods Retrospective cohort study using the NCDB. Individuals with AJCC clinical T3/T4 pancreatic car...

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Veröffentlicht in:Annals of surgical oncology 2019-10, Vol.26 (11), p.3701-3708
Hauptverfasser: Vidri, Roberto J., Vogt, Anne O., Macgillivray, Dougald C., Bristol, Ian J., Fitzgerald, Timothy L.
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Sprache:eng
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Zusammenfassung:Background This study was designed to better define the role of radiation (Neo-Rad) in addition to neoadjuvant multiagent chemotherapy (NAT) for the treatment of locally advanced pancreatic cancer. Methods Retrospective cohort study using the NCDB. Individuals with AJCC clinical T3/T4 pancreatic carcinoma who underwent resection and multiagent chemotherapy were included. Kaplan–Meier, logistic-regression, and Cox proportional-hazard models were used for analysis. Results A total of 2703 patients were included; 2039 had T3 and 664 had T4 tumors, and 1092 (40.4%) received Neo-Rad. Median follow-up was 22.5 months. During the study period, there was increased use of NAT and a decline in the use of Neo-Rad. Addition of Neo-Rad did not affect 30-day (2.51% vs. 3.24%, p  = 0.272) or 90-day mortality (5.23% vs. 6.38%, p  = 0.216). Neo-Rad was not associated with improved overall survival on univariable (25.95 vs. 24.7 months, p  = 0.202), or multivariable analyses (hazard ratio [HR] 0.94; 95% confidence interval [CI] 0.85–1.05). Time from diagnosis to definitive surgery was increased by Neo-Rad (204 vs. 115 days, p  
ISSN:1068-9265
1534-4681
1534-4681
DOI:10.1245/s10434-019-07584-5