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 |
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| creator | Vidri, Roberto J. Vogt, Anne O. Macgillivray, Dougald C. Bristol, Ian J. Fitzgerald, Timothy L. |
| description | 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
|
| doi_str_mv | 10.1245/s10434-019-07584-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_osti_</sourceid><recordid>TN_cdi_osti_scitechconnect_22927567</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2253641004</sourcerecordid><originalsourceid>FETCH-LOGICAL-c403t-4b405ce70f0cfa13d4365f631a0ea9560c138bb9284c045daa0bd19260a329f93</originalsourceid><addsrcrecordid>eNp9kU9PGzEQxa2qqEDaL9BDZannhfHf3eUGaQtIUYsQPVte72yy0cYG26nEt8chFG6cbM383ht7HiFfGZwwLtVpYiCFrIC1FdSqkZX6QI6YKiWpG_ax3EE3Vcu1OiTHKa0BWC1AfSKHgvFGC9BH5OECc8ZIf-Aw-tEvaV4hvQ0T0jDQu5DtRH9jsP16-8_6TG9tP9o8Bn9G5yvrlzvFjY2lutwkOnq6CM5O0yM97wvvsC9d7yIWjaPzXSV-JgeDnRJ-eTln5O-vn3fzq2rx5_J6fr6onASRK9lJUA5rGMANloleCq0GLZgFtK3S4Jhouq7ljXQgVW8tdD0rnwUreDu0Yka-731DyqNJbszoVi54jy4bzlteK12_UfcxPGwxZbMO2-jLwwqjhJYMypJnhO8pF0NKEQdzH8eNjY-GgdllYfZZmJKFec7CqCL69mK97TbYv0r-L78AYg-k0vJLjG-z37F9AvIAkzU</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2253641004</pqid></control><display><type>article</type><title>Better Defining the Role of Total Neoadjuvant Radiation: Changing Paradigms in Locally Advanced Pancreatic Cancer</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Vidri, Roberto J. ; Vogt, Anne O. ; Macgillivray, Dougald C. ; Bristol, Ian J. ; Fitzgerald, Timothy L.</creator><creatorcontrib>Vidri, Roberto J. ; Vogt, Anne O. ; Macgillivray, Dougald C. ; Bristol, Ian J. ; Fitzgerald, Timothy L.</creatorcontrib><description>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
< 0.001). Neo-Rad was associated with increased pathologic downstaging in T3 (32.8% vs. 14.4%) (odds ratio [OR] 2.90; 95% CI 2.30–3.66) and T4 tumors (88.9% vs. 77.8%) (OR 2.29; 95% CI 1.44–3.67); complete pathologic response (5.3% vs. 1.6%) (OR 2.89; 95% CI 1.73–4.83), and increased R0 resection rates (85.7% vs. 76.8%) (OR 1.79; 95% CI 1.44–2.23).
Conclusions
The use of neoadjuvant therapy is increasing for the treatment of locally advanced pancreatic cancer. The addition of radiation to neoadjuvant chemotherapy is associated with improved antineoplastic effectiveness (downstaging, complete pathologic response), surgical resection (R0 rates), but has no effect on overall survival.</description><identifier>ISSN: 1068-9265</identifier><identifier>ISSN: 1534-4681</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-019-07584-5</identifier><identifier>PMID: 31286306</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adenocarcinoma - pathology ; Adenocarcinoma - radiotherapy ; Cancer therapies ; CARCINOMAS ; CHEMOTHERAPY ; DIAGNOSIS ; Female ; Follow-Up Studies ; HAZARDS ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; MORTALITY ; Neoadjuvant Therapy - mortality ; Oncology ; PANCREAS ; Pancreatic cancer ; Pancreatic carcinoma ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - radiotherapy ; Pancreatic Tumors ; PATIENTS ; Prognosis ; RADIOLOGY AND NUCLEAR MEDICINE ; Radiotherapy, Adjuvant - mortality ; Regression analysis ; Retrospective Studies ; SURGERY ; Surgical Oncology ; Survival ; Survival Rate ; Tumors</subject><ispartof>Annals of surgical oncology, 2019-10, Vol.26 (11), p.3701-3708</ispartof><rights>Society of Surgical Oncology 2019</rights><rights>Annals of Surgical Oncology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c403t-4b405ce70f0cfa13d4365f631a0ea9560c138bb9284c045daa0bd19260a329f93</citedby><cites>FETCH-LOGICAL-c403t-4b405ce70f0cfa13d4365f631a0ea9560c138bb9284c045daa0bd19260a329f93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-019-07584-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-019-07584-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31286306$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22927567$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Vidri, Roberto J.</creatorcontrib><creatorcontrib>Vogt, Anne O.</creatorcontrib><creatorcontrib>Macgillivray, Dougald C.</creatorcontrib><creatorcontrib>Bristol, Ian J.</creatorcontrib><creatorcontrib>Fitzgerald, Timothy L.</creatorcontrib><title>Better Defining the Role of Total Neoadjuvant Radiation: Changing Paradigms in Locally Advanced Pancreatic Cancer</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>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
< 0.001). Neo-Rad was associated with increased pathologic downstaging in T3 (32.8% vs. 14.4%) (odds ratio [OR] 2.90; 95% CI 2.30–3.66) and T4 tumors (88.9% vs. 77.8%) (OR 2.29; 95% CI 1.44–3.67); complete pathologic response (5.3% vs. 1.6%) (OR 2.89; 95% CI 1.73–4.83), and increased R0 resection rates (85.7% vs. 76.8%) (OR 1.79; 95% CI 1.44–2.23).
Conclusions
The use of neoadjuvant therapy is increasing for the treatment of locally advanced pancreatic cancer. The addition of radiation to neoadjuvant chemotherapy is associated with improved antineoplastic effectiveness (downstaging, complete pathologic response), surgical resection (R0 rates), but has no effect on overall survival.</description><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - radiotherapy</subject><subject>Cancer therapies</subject><subject>CARCINOMAS</subject><subject>CHEMOTHERAPY</subject><subject>DIAGNOSIS</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>HAZARDS</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>MORTALITY</subject><subject>Neoadjuvant Therapy - mortality</subject><subject>Oncology</subject><subject>PANCREAS</subject><subject>Pancreatic cancer</subject><subject>Pancreatic carcinoma</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - radiotherapy</subject><subject>Pancreatic Tumors</subject><subject>PATIENTS</subject><subject>Prognosis</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>Radiotherapy, Adjuvant - mortality</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>SURGERY</subject><subject>Surgical Oncology</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>Tumors</subject><issn>1068-9265</issn><issn>1534-4681</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kU9PGzEQxa2qqEDaL9BDZannhfHf3eUGaQtIUYsQPVte72yy0cYG26nEt8chFG6cbM383ht7HiFfGZwwLtVpYiCFrIC1FdSqkZX6QI6YKiWpG_ax3EE3Vcu1OiTHKa0BWC1AfSKHgvFGC9BH5OECc8ZIf-Aw-tEvaV4hvQ0T0jDQu5DtRH9jsP16-8_6TG9tP9o8Bn9G5yvrlzvFjY2lutwkOnq6CM5O0yM97wvvsC9d7yIWjaPzXSV-JgeDnRJ-eTln5O-vn3fzq2rx5_J6fr6onASRK9lJUA5rGMANloleCq0GLZgFtK3S4Jhouq7ljXQgVW8tdD0rnwUreDu0Yka-731DyqNJbszoVi54jy4bzlteK12_UfcxPGwxZbMO2-jLwwqjhJYMypJnhO8pF0NKEQdzH8eNjY-GgdllYfZZmJKFec7CqCL69mK97TbYv0r-L78AYg-k0vJLjG-z37F9AvIAkzU</recordid><startdate>20191001</startdate><enddate>20191001</enddate><creator>Vidri, Roberto J.</creator><creator>Vogt, Anne O.</creator><creator>Macgillivray, Dougald C.</creator><creator>Bristol, Ian J.</creator><creator>Fitzgerald, Timothy L.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>OTOTI</scope></search><sort><creationdate>20191001</creationdate><title>Better Defining the Role of Total Neoadjuvant Radiation: Changing Paradigms in Locally Advanced Pancreatic Cancer</title><author>Vidri, Roberto J. ; Vogt, Anne O. ; Macgillivray, Dougald C. ; Bristol, Ian J. ; Fitzgerald, Timothy L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c403t-4b405ce70f0cfa13d4365f631a0ea9560c138bb9284c045daa0bd19260a329f93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - radiotherapy</topic><topic>Cancer therapies</topic><topic>CARCINOMAS</topic><topic>CHEMOTHERAPY</topic><topic>DIAGNOSIS</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>HAZARDS</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>MORTALITY</topic><topic>Neoadjuvant Therapy - mortality</topic><topic>Oncology</topic><topic>PANCREAS</topic><topic>Pancreatic cancer</topic><topic>Pancreatic carcinoma</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - radiotherapy</topic><topic>Pancreatic Tumors</topic><topic>PATIENTS</topic><topic>Prognosis</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>Radiotherapy, Adjuvant - mortality</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>SURGERY</topic><topic>Surgical Oncology</topic><topic>Survival</topic><topic>Survival Rate</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vidri, Roberto J.</creatorcontrib><creatorcontrib>Vogt, Anne O.</creatorcontrib><creatorcontrib>Macgillivray, Dougald C.</creatorcontrib><creatorcontrib>Bristol, Ian J.</creatorcontrib><creatorcontrib>Fitzgerald, Timothy L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>OSTI.GOV</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vidri, Roberto J.</au><au>Vogt, Anne O.</au><au>Macgillivray, Dougald C.</au><au>Bristol, Ian J.</au><au>Fitzgerald, Timothy L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Better Defining the Role of Total Neoadjuvant Radiation: Changing Paradigms in Locally Advanced Pancreatic Cancer</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2019-10-01</date><risdate>2019</risdate><volume>26</volume><issue>11</issue><spage>3701</spage><epage>3708</epage><pages>3701-3708</pages><issn>1068-9265</issn><issn>1534-4681</issn><eissn>1534-4681</eissn><abstract>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
< 0.001). Neo-Rad was associated with increased pathologic downstaging in T3 (32.8% vs. 14.4%) (odds ratio [OR] 2.90; 95% CI 2.30–3.66) and T4 tumors (88.9% vs. 77.8%) (OR 2.29; 95% CI 1.44–3.67); complete pathologic response (5.3% vs. 1.6%) (OR 2.89; 95% CI 1.73–4.83), and increased R0 resection rates (85.7% vs. 76.8%) (OR 1.79; 95% CI 1.44–2.23).
Conclusions
The use of neoadjuvant therapy is increasing for the treatment of locally advanced pancreatic cancer. The addition of radiation to neoadjuvant chemotherapy is associated with improved antineoplastic effectiveness (downstaging, complete pathologic response), surgical resection (R0 rates), but has no effect on overall survival.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>31286306</pmid><doi>10.1245/s10434-019-07584-5</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2019-10, Vol.26 (11), p.3701-3708 |
| issn | 1068-9265 1534-4681 1534-4681 |
| language | eng |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Adenocarcinoma - pathology Adenocarcinoma - radiotherapy Cancer therapies CARCINOMAS CHEMOTHERAPY DIAGNOSIS Female Follow-Up Studies HAZARDS Humans Male Medicine Medicine & Public Health Middle Aged MORTALITY Neoadjuvant Therapy - mortality Oncology PANCREAS Pancreatic cancer Pancreatic carcinoma Pancreatic Neoplasms - pathology Pancreatic Neoplasms - radiotherapy Pancreatic Tumors PATIENTS Prognosis RADIOLOGY AND NUCLEAR MEDICINE Radiotherapy, Adjuvant - mortality Regression analysis Retrospective Studies SURGERY Surgical Oncology Survival Survival Rate Tumors |
| title | Better Defining the Role of Total Neoadjuvant Radiation: Changing Paradigms in Locally Advanced Pancreatic Cancer |
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