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1. Adjuvant chemoradiation in pancreatic cancer: impact of radiotherapy dose on survival

Author

Alessio G. Morganti, Francesco Cellini, Milly Buwenge, Alessandra Arcelli, Sergio Alfieri, Felipe A. Calvo, Riccardo Casadei, Savino Cilla, Francesco Deodato, Giancarmine Di Gioia, Mariacristina Di Marco, Lorenzo Fuccio, Federica Bertini, Alessandra Guido, Joseph M. Herman, Gabriella Macchia, Bert W. Maidment, Robert C. Miller, Francesco Minni, Paolo Passoni, Chiara Valentini, Alessia Re, William F. Regine, Michele Reni, Massimo Falconi, Vincenzo Valentini, and Gian Carlo Mattiucci

Subjects
Pancreatic neoplasm, Radiotherapy, Adjuvant, Dose effect, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

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:

Published
2019
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2. Adjuvant chemoradiation in pancreatic cancer: impact of radiotherapy dose on survival

Author

Gian Carlo Mattiucci, Alessio G. Morganti, Lorenzo Fuccio, Michele Reni, Alessia Re, Felipe A. Calvo, Alessandra Arcelli, Francesco Cellini, Sergio Alfieri, Robert C. Miller, William F. Regine, Massimo Falconi, Vincenzo Valentini, Giancarmine Di Gioia, F. Bertini, Chiara Valentini, Joseph M. Herman, Riccardo Casadei, Milly Buwenge, Francesco Minni, Paolo Passoni, Mariacristina Di Marco, Savino Cilla, Francesco Deodato, Bert W. Maidment, Gabriella Macchia, Alessandra Guido, Morganti A.G., Cellini F., Buwenge M., Arcelli A., Alfieri S., Calvo F.A., Casadei R., Cilla S., Deodato F., Di Gioia G., Di Marco M., Fuccio L., Bertini F., Guido A., Herman J.M., Macchia G., Maidment B.W., Miller R.C., Minni F., Passoni P., Valentini C., Re A., Regine W.F., Reni M., Falconi M., Valentini V., Mattiucci G.C., Morganti, A. G., Cellini, F., Buwenge, M., Arcelli, A., Alfieri, S., Calvo, F. A., Casadei, R., Cilla, S., Deodato, F., Di Gioia, G., Di Marco, M., Fuccio, L., Bertini, F., Guido, A., Herman, J. M., Macchia, G., Maidment, B. W., Miller, R. C., Minni, F., Passoni, P., Valentini, C., Re, A., Regine, W. F., Reni, M., Falconi, M., Valentini, V., and Mattiucci, G. C.

Subjects
Male, 0301 basic medicine, Cancer Research, medicine.medical_treatment, Kaplan-Meier Estimate, Gastroenterology, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Surgical oncology, 80 and over, Stage (cooking), Pancreatic neoplasm, Adjuvant, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Aged, 80 and over, Univariate analysis, Radiation, Radiotherapy Dosage, Chemoradiotherapy, Middle Aged, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Tumor Burden, Treatment Outcome, Oncology, Pancreatic Ductal, 030220 oncology & carcinogenesis, Female, Dose effect, Research Article, Carcinoma, Pancreatic Ductal, Adult, medicine.medical_specialty, CA-19-9 Antigen, lcsh:RC254-282, Dose-Response Relationship, 03 medical and health sciences, Radiotherapy, Aged, Chemoradiotherapy, Adjuvant, Dose-Response Relationship, Radiation, Follow-Up Studies, Humans, Lymph Nodes, Multivariate Analysis, Neoplasm Grading, Pancreatic Neoplasms, Retrospective Studies, Pancreatic cancer, Internal medicine, Genetics, medicine, business.industry, Carcinoma, Retrospective cohort study, medicine.disease, Radiation therapy, 030104 developmental biology, business
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.

Published
2019

3. Adjuvant chemoradiation in pancreatic cancer: impact of radiotherapy dose on survival.

Author

Morganti, Alessio G., Cellini, Francesco, Buwenge, Milly, Arcelli, Alessandra, Alfieri, Sergio, Calvo, Felipe A., Casadei, Riccardo, Cilla, Savino, Deodato, Francesco, Di Gioia, Giancarmine, Di Marco, Mariacristina, Fuccio, Lorenzo, Bertini, Federica, Guido, Alessandra, Herman, Joseph M., Macchia, Gabriella, Maidment III, Bert W., Miller, Robert C., Minni, Francesco, and Passoni, Paolo

Subjects
CANCER radiotherapy, PANCREATIC cancer, CHEMORADIOTHERAPY, ADJUVANT treatment of cancer, LOG-rank test
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. [ABSTRACT FROM AUTHOR]

Published
2019
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