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Identifying Clinical Factors Which Predict for Early Failure Patterns Following Resection for Pancreatic Adenocarcinoma in Patients Who Received Adjuvant Chemotherapy Without Chemoradiation

Walston, Steve, DO, MS; Salloum, Joseph, BS; Grieco, Carmine, MD; Wuthrick, Evan, MD; Diaz, Dayssy A., MD; Barney, Christian, MD; Manilchuk, Andrei, MD; Schmidt, Carl, MD; Dillhoff, Mary, MD; Pawlik, Timothy M., MD, MPH, PhD; Williams, Terence M., MD, PhD

American Journal of Clinical Oncology: December 2018 - Volume 41 - Issue 12 - p 1185–1192
doi: 10.1097/COC.0000000000000452
Original Articles: Gastrointestinal

Objectives: The role of radiation therapy (RT) in resected pancreatic cancer (PC) remains incompletely defined. We sought to determine clinical variables which predict for local-regional recurrence (LRR) to help select patients for adjuvant RT.

Materials and Methods: We identified 73 patients with PC who underwent resection and adjuvant gemcitabine-based chemotherapy alone. We performed detailed radiologic analysis of first patterns of failure. LRR was defined as recurrence of PC within standard postoperative radiation volumes. Univariate analyses (UVA) were conducted using the Kaplan-Meier method and multivariate analyses (MVA) utilized the Cox proportional hazard ratio model. Factors significant on UVA were used for MVA.

Results: At median follow-up of 20 months, rates of local-regional recurrence only (LRRO) were 24.7%, LRR as a component of any failure 68.5%, metastatic recurrence (MR) as a component of any failure 65.8%, and overall disease recurrence (OR) 90.5%. On UVA, elevated postoperative CA 19-9 (>90 U/mL), pathologic lymph node positive (pLN+) disease, and higher tumor grade were associated with increased LRR, MR, and OR. On MVA, elevated postoperative CA 19-9 and pLN+ were associated with increased MR and OR. In addition, positive resection margin was associated with increased LRRO on both UVA and MVA.

Conclusions: About 25% of patients with PC treated without adjuvant RT develop LRRO as initial failure. The only independent predictor of LRRO was positive margin, while elevated postoperative CA 19-9 and pLN+ were associated with predicting MR and overall survival. These data may help determine which patients benefit from intensification of local therapy with radiation.

The Ohio State University Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, OH

Supported by the following grants: Award Number Grant KL2TR001068 from the National Center for Advancing Translational Sciences, and NIH R01 CA198128 (T.M.W.).

Presented at the American Society of Radiation Oncology (ASTRO) Annual Meeting, 2015, San Antonio, TX.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.

The authors declare no conflicts of interest.

Reprints: Terence M. Williams, MD, PhD, Department of Radiation Oncology, The Ohio State University, 460 W. 12th Avenue, Columbus, OH 43210. E-mail:

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