Local control and survival after induction chemotherapy and ablative radiation versus resection for pancreatic ductal adenocarcinoma with vascular involvement Journal Article
| Authors: | Jolissaint, J. S.; Reyngold, M.; Bassmann, J.; Seier, K. P.; Gönen, M.; Varghese, A. M.; Yu, K. H.; Park, W.; O'Reilly, E. M.; Balachandran, V. P.; D'Angelica, M. I.; Drebin, J. A.; Kingham, T. P.; Soares, K. C.; Jarnagin, W. R.; Crane, C. H.; Wei, A. C. |
| Article Title: | Local control and survival after induction chemotherapy and ablative radiation versus resection for pancreatic ductal adenocarcinoma with vascular involvement |
| Abstract: | Objective:We sought to compare overall survival (OS) and disease control for patients with localized pancreatic ductal adenocarcinoma (PDAC) treated with ablative dose radiotherapy (A-RT) versus resection.Summary Background Data:Locoregional treatment for PDAC includes resection when possible or palliative RT. A-RT may offer durable tumor control and encouraging survival.Methods:This was a single-institution retrospective analysis of patients with PDAC treated with induction chemotherapy followed by A-RT [≥98 Gy biologically effective dose (BED) using 15-25 fractions in 3-4.5 Gy/fraction] or pancreatectomy.Results:One hundred and four patients received A-RT (49.8%) and 105 (50.2%) underwent resection. Patients receiving A-RT had larger median tumor size after induction chemotherapy [3.2 cm (undetectable-10.9) vs 2.6 cm (undetectable-10.7), P < 0.001], and were more likely to have celiac or hepatic artery encasement (48.1% vs 11.4%, P <0.001), or superior mesenteric artery encasement (43.3% vs 9.5%, P < 0.001); however, there was no difference in the degree of SMV/PV involvement (P = 0.123). There was no difference in locoregional recurrence/progression at 18-months between A-RT and resection; cumulative incidence was 16% [(95% confidence interval (CI) 10%-24%] versus 21% (95% CI 14%-30%), respectively (P= 0.252). However, patients receiving A-RT had a 19% higher 18-month cumulative incidence of distant recurrence/progression [58% (95% CI 48%-67%) vs 30% (95% CI 30%-49%), P= 0.004]. Median OS from completion of chemotherapy was 20.1 months for A-RT patients (95% CI 16.4-23.1 months) versus 32.9 months (95% CI 29.7-42.3 months) for resected patients (P < 0.001).Conclusion:Ablative radiation is a promising new treatment option for PDAC, offering locoregional disease control similar to that associated with resection and encouraging survival. © 2021 Lippincott Williams and Wilkins. All rights reserved. |
| Keywords: | adult; cancer survival; controlled study; aged; aged, 80 and over; middle aged; survival analysis; retrospective studies; major clinical study; overall survival; mortality; cancer recurrence; cancer growth; gemcitabine; paclitaxel; pancreatic neoplasms; radiotherapy, adjuvant; antineoplastic agent; pancreaticoduodenectomy; vascular neoplasms; radiotherapy dosage; ca 19-9 antigen; carcinoma, pancreatic ductal; cohort analysis; pathology; retrospective study; pancreas carcinoma; postoperative complication; stomach ulcer; pancreas tumor; cancer size; vascular tumor; pancreatectomy; radiation therapy; neoplasm invasiveness; pancreatic cancer; duodenum stenosis; cancer control; dyspepsia; adjuvant radiotherapy; outcomes; hepatic artery; chemoradiotherapy; induction chemotherapy; spleen artery; cholestasis; duodenum ulcer; cumulative incidence; celiac artery; superior mesenteric artery; comparative effectiveness; pancreatic ductal carcinoma; tumor invasion; stent migration; surgical oncology; superior mesenteric vein; local recurrence free survival; splenic vein; response evaluation criteria in solid tumors; cholangitis; gastroduodenal artery; upper gastrointestinal bleeding; very elderly; humans; human; male; female; article; vertebral body fracture; effective dose (radiation); in-stent restenosis; hepatic portal vein; local progression free survival; distant recurrence free survival; distant progression free survival |
| Journal Title: | Annals of Surgery |
| Volume: | 274 |
| Issue: | 6 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2021-12-01 |
| Start Page: | 894 |
| End Page: | 901 |
| Language: | English |
| DOI: | 10.1097/sla.0000000000005080 |
| PUBMED: | 34269717 |
| PROVIDER: | scopus |
| PMCID: | PMC8599622 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Alice C. Wei -- Source: Scopus |
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