R1 pancreatic cancer patients benefit from chemoradiation when initiation of adjuvant therapy is delayed

Ariana M Chirban; Eduardo A Vega; Onur C Kutlu; Sebastian Mellado; Olga Kozyreva; Andris J Zauls; Elena Panettieri; Oscar Salirrosas; Richard Freeman; Claudius Conrad

doi:10.1016/j.suronc.2023.101961

R1 pancreatic cancer patients benefit from chemoradiation when initiation of adjuvant therapy is delayed

Surg Oncol. 2023 Aug:49:101961. doi: 10.1016/j.suronc.2023.101961. Epub 2023 Jun 10.

Authors

Affiliations

¹ University of California, San Diego School of Medicine, 9500 Gilman Dr., La Jolla, CA, 92093, USA; Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA.
² Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA.
³ Department of Surgery, Miller School of Medicine, University of Miami, 1120 NW 14th St f4, Miami, FL, 33136, USA.
⁴ Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA.
⁵ Dana-Farber Cancer Institute, Harvard School of Medicine, 450 Brookline Ave, Boston, MA, 02215, USA.
⁶ Good Samaritan Medical Center, Radiation Oncology, 818 Oak Street, Brockton, MA, USA.
⁷ Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA; Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Via della Pineta Sacchetti, 217, 00168, Roma RM, Italy.
⁸ Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA. Electronic address: claudius.conrad@steward.org.

PMID: 37321066
DOI: 10.1016/j.suronc.2023.101961

Abstract

Background: Adjuvant chemotherapy (AC) following pancreaticoduodenectomy (PD) for pancreas cancer (PDAC) has been demonstrated to improve survival. However, the optimal adjuvant treatment (AT) regimen for R1-margin patients remains unclear. This retrospective study investigates the impact of AC vs. adjuvant chemoradiotherapy (ACRT) on survival (OS).

Material and methods: The NCDB was queried for patients with PDAC who underwent PD between 2010 and 2018. Patients were divided into, (A) AC<60 days, (B) ACRT<60 days, (C) AC≥60 days, and (D) ACRT≥60 days. Kaplan-Meier survival analyses and Cox multivariable regression analyses were performed.

Results: Among 13 740 patients, median OS was 23.7 months. For R1 patients, median OS for timely AC and ACRT, and delayed AC and ACRT was 19.91, 19.19, 15.24, 18.96 months, respectively. While time of AC initiation was an insignificant factor for R0 patients (p = 0.263, CI 0.957-1.173), a survival benefit was found for R1 patients who received AC<60 vs. ≥60 days (p = 0.041, CI 1.002-1.42). Among R1 patients, administration of delayed ACRT achieves the same survival benefit of timely AC initiation (p = 0.074, CI 0.703-1.077).

Conclusion: The study suggests value in ACRT for patients with R1 margins when delay of AT≥60 days cannot be avoided. Hence, ACRT may mitigate the negative impact of delayed AT initiation for R1-patients.

Keywords: Adjuvant chemoradiotherapy; Adjuvant chemotherapy; NCDB; Overall survival; Pancreatic ductal adenocarcinoma; Pancreaticoduodenectomy.

MeSH terms

Carcinoma, Pancreatic Ductal* / therapy
Chemoradiotherapy, Adjuvant
Chemotherapy, Adjuvant
Combined Modality Therapy
Humans
Pancreatic Neoplasms* / therapy
Retrospective Studies