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Adjuvant Gemcitabine and Gemcitabine-based Chemoradiotherapy Versus Gemcitabine Alone After Pancreatic Cancer Resection: The Indiana University Experience

Khawaja, Muhammad R. MD, MPH; Kleyman, Svetlana MD; Yu, Zhangsheng PhD; Howard, Thomas MD; Burns, Matthew; Nakeeb, Attila MD; Loehrer, Patrick J. Sr MD; Cardenes, Higinia R. MD; Chiorean, Elena Gabriela MD

American Journal of Clinical Oncology:
doi: 10.1097/COC.0000000000000115
Original Articles: Gastrointestinal
Abstract

Objectives: Adjuvant therapy after surgical resection is the current standard for pancreatic adenocarcinoma; however, the role of chemoradiotherapy (CRT) remains unclear. This study was conducted to compare the efficacy outcomes with adjuvant gemcitabine and gemcitabine-based CRT (CT-CRT) versus gemcitabine chemotherapy (CT) alone after pancreaticoduodenectomy.

Methods: Among 165 patients who underwent surgical resection for pancreatic cancer at Indiana University Medical Center between 2004 and 2008, we retrospectively identified 53 consecutive patients who received adjuvant therapy (CT-CRT=34 patients; CT=19 patients) and had adequate follow-up medical records. The median follow-up was 19.1 months. Median disease-free (DFS) and overall survival (OS) were determined using Kaplan-Meier method, and a Cox-regression model was used to compare survival outcomes after adjusting for age, status of resection margins, and lymph node involvement.

Results: The OS for the CT-CRT group was significantly higher compared with the CT group (median, 20.4 vs. 16.6 mo; hazard ratio, 2.42; 95% CI, 1.17-5.01). The median DFS for the CT-CRT group was 13.7 versus 11.1 months for the CT group (hazard ratio, 2.88; 95% CI, 1.37-6.06). On subgroup analyses, significantly superior OS and DFS were observed among patients younger than 65 years, T3/T4 tumor stage, negative resection margins, and positive lymph node involvement.

Conclusion: Gemcitabine plus gemcitabine-based CRT compared with gemcitabine alone leads to superior DFS and OS for patients with resected pancreatic cancer.

Author Information

*Division of Hematology/Oncology

Departments of Biostatistics

Surgery

§Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN

Department of Medicine, Division of Hematology/Oncology, University of Washington, Seattle, WA

The authors declare no conflicts of interest.

Reprints: E. Gabriela Chiorean, MD, Department of Medicine, Division of Hematology/Oncology, University of Washington, 825 Eastlake Ave East, G4830, Seattle, WA 98109. E-mail: gchiorea@uw.edu.

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