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    Adjuvant chemoradiation in pancreatic cancer: Impact of radiotherapy dose on survival

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    Author
    Morganti, A.G.
    Cellini, F.
    Buwenge, M.
    Date
    2019
    Journal
    BMC Cancer
    Publisher
    BioMed Central Ltd.
    Type
    Article
    
    Metadata
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    See at
    https://doi.org/10.1186/s12885-019-5790-2
    Abstract
    Background To evaluate the impact of radiation dose on overall survival (OS) in patients treated with adjuvant chemoradiation (CRT) for pancreatic ductal adenocarcinoma (PDAC). Methods A multicenter retrospective analysis on 514 patients with PDAC (T1–4; N0–1; M0) treated with surgical resection with macroscopically negative margins (R0–1) followed by adjuvant CRT was performed. Patients were stratified into 4 groups based on radiotherapy doses (group 1: < 45 Gy, group 2: ≥ 45 and < 50 Gy, group 3: ≥ 50 and < 55 Gy, group 4: ≥ 55 Gy). Adjuvant chemotherapy was prescribed to 141 patients. Survival functions were plotted using the Kaplan-Meier method and compared through the log-rank test. Results Median follow-up was 35 months (range: 3–120 months). At univariate analysis, a worse OS was recorded in patients with higher preoperative Ca 19.9 levels (≥ 90 U/ml; p < 0.001), higher tumor grade (G3–4, p = 0.004), R1 resection (p = 0.004), higher pT stage (pT3–4, p = 0.002) and positive nodes (p < 0.001). Furthermore, patients receiving increasing doses of CRT showed a significantly improved OS. In groups 1, 2, 3, and 4, median OS was 13.0 months, 21.0 months, 22.0 months, and 28.0 months, respectively (p = 0.004). The significant impact of higher dose was confirmed by multivariate analysis. Conclusions Increasing doses of CRT seems to favorably impact on OS in adjuvant setting. The conflicting results of randomized trials on adjuvant CRT in PDAC could be due to < 45 Gy dose generally used. Copyright 2019 The Author(s).
    Keyword
    Adjuvant
    Dose effect
    Pancreatic neoplasm
    Radiotherapy
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85067096632&doi=10.1186%2fs12885-019-5790-2&partnerID=40&md5=b1a6eab9260a20e2e938b8f2847f2a96; http://hdl.handle.net/10713/10542
    ae974a485f413a2113503eed53cd6c53
    10.1186/s12885-019-5790-2
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    UMB Open Access Articles 2019

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