Chemoradiation After Pancreaticoduodenectomy for Pancreatic Adenocarcinoma is it of Proven Benefit?

Objective: This study was designed to evaluate prospectively survival after pancreaticoduodenect-omy for pancreatic adenocarcinoma, comparing two different postoperative adjuvant chemoradiation protocols to those of no adjuvant therapy. Summary Background Data: Based on limited data from the Gastrointestinal Tumor Study Group. Adjuvant chemoradiation therapy has been recommended after pancreaticoduodenectomy for adeno-carcinoma of the head, neck, or uncinate process of the pancreas. However, many patients continue to receive no such therapy. confirmed adenocarcinoma of the head, neck, or uncinate process of the pancreas were reviewed by a multidisciplinary group (surgery, radiation oncology , medical oncology, and pathology) and were offered three options for postoperative treatment after pancreaticoduodenectomy: 1) standard therapy: external beam radiation therapy to the pancreatic bed (4000-4500 cGy) given with two 3-day fluorour-acil (5-FU) courses and followed by weekly bolus 5-FU (500mg/m 2 per day) for 4 months: 2) intensive therapy: external beam radiation therapy to the pancreatic bed (5040-5760cGy) with prophylactic hepatic irradiation (2340-2700 cGy) given with and followed by infusional 5-FU (200mg/m 2 per day) plus leucovorin (5 mg/m 2 per day) for 5 of 7 days for 4months: or 3) no therapy: no postoperative radiation therapy or chemotherapy. Results: Pancreaticoduodenectomy was performed in 174 patients, with 1 in-hospital death (0.6%). Ninety-nine patients elected standard therepy, 21 elected intensive therapy and 53 patients declined therapy. The three groups were comparable with respect to race, gender, intraoperative blood loss, tumor differentiation, lymph node status, tumor diameter, and resection margin status. Univariate analyses indicated that tumor diameter <3cm, intraoperative blood loss <700mL, absence of in-traoperative blood transfusions, and use of adjuvant chemoradiation therapy were associated with significantly longer survival (p < 0.05). By Cox proportional hazards survival analysis, the most powerful predictors of outcome were tumor diameter, intrao-perative blood loss, status of resection margins, and use of postoperative adjuvant thereapy. The use of postoperative adjuvant chemoradiation therapy was a predictor of improved survival (median survival, 19.5 months compared to 13.5 months without therapy ; p 0.003). The intensive therapy group had no survival advantage when compared to that of the standard therapy group (median survival, 17.5 months vs. 21 months, p not significant). Conclusions: Adjuvant chemoradiation therapy sig-nifcantly improves survival after pancreaticoduode-nectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas. Based on these survival data, standard adjuvant chemoradiation therapy appears to be indicated for patients treated by pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate …