December 18, 2008 - Therapeutic strategies that use neoadjuvant RT for patients with resectable pancreatic cancer showed a survival benefit over surgery alone or surgery with adjuvant RT in treating pancreatic cancer, according to a study published in the November 2008 issue of the International Journal of Radiation Oncology Biology Physics.
Cancer of the exocrine pancreas is the fifth leading cause of cancer death in the U.S. Neoadjuvant chemoradiation has been investigated in several trials as a strategy for downstaging locally advanced disease to resectability.
The aim of the study was to examine the effect of neoadjuvant radiation therapy (RT) versus other treatments on long-term survival for patients with resectable pancreatic cancer in a large population-based sample group.
The Surveillance, Epidemiology and End Results (SEER) registry database (1994–2003) was queried for cases of surgically resected pancreatic cancer. Retrospective analysis was performed. The endpoint of the study was overall survival.
Using Kaplan-Meier analysis, the researchers found that the median overall survival of patients receiving neoadjuvant RT was 23 months versus 12 months with no RT and 17 months with adjuvant RT. Using Cox regression and controlling for independent covariates (age, sex, stage, grade, and year of diagnosis), the researchers found that neoadjuvant RT results in significantly higher rates of survival than other treatments (hazard ratio [HR], 0.55; 95 percent confidence interval, 0.38–0.79; p = 0.001). Specifically comparing adjuvant with neoadjuvant RT, results showed a significantly lower HR for death in patients receiving neoadjuvant RT rather than adjuvant RT (HR, 0.63; 95 percent confidence interval, 0.45–0.90; p = 0.03).
This analysis of SEER data showed a survival benefit for the use of neoadjuvant RT over surgery alone or surgery with adjuvant RT in treating pancreatic cancer. Therapeutic strategies that use neoadjuvant RT should be further explored for patients with resectable pancreatic cancer.
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