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Comparative Study
. 2011 Jan;13(1):64-9.
doi: 10.1111/j.1477-2574.2010.00245.x. Epub 2010 Dec 7.

Pancreatic head resectable adenocarcinoma: preoperative chemoradiation improves local control but does not affect survival

Louise Barbier  1 , Olivier Turrini, Emilie Grégoire, Frédéric Viret, Yves-Patrice Le Treut, Jean-Robert Delpero
Affiliations
Comparative Study

Pancreatic head resectable adenocarcinoma: preoperative chemoradiation improves local control but does not affect survival

Louise Barbier et al. HPB (Oxford). 2011 Jan.

Erratum in

  • HPB (Oxford). 2011 Dec;13(12):899

Abstract

Background: This study assesses the impact of preoperative chemoradiation on recurrence, surgical morbidity, histopathological data and survival in resectable adenocarcinoma of the pancreatic head.

Methods: We carried out a retrospective study with an intention-to-treat analysis. From 1997 to 2006, 173 patients with resectable pancreas head carcinoma were treated in two reference centres in France using different treatment strategies.

Results: Sixty-seven of 85 (79%) patients in the surgery-first (SF) group and 38 of 88 (43%) patients in the chemoradiation (CR) group underwent surgical resection (P < 0.001). Overall morbidity was 40% (15/38) in the CR group and 43% (29/67) in the SF group (P= 0.837). In the CR group, median tumour size was smaller (1.5 cm vs. 3.0 cm; P < 0.001) and fewer patients were node-positive (29% vs. 64%; P= 0.001) than in the SF group. There was less perineural (43% vs. 93%; P < 0.001), lymphatic and vascular (21% vs. 92%; P < 0.001) invasion in the CR group than in the SF group. In both groups, 89% of patients had recurrence (31/35 in the CR group and 57/64 in the SF group; P= 1.000), predominantly involving metastasis and carcinomatosis in the CR group (30/31 vs. 35/57; P < 0.001) and locoregional recurrence in the SF group (24/57 vs. 3/31; P= 0.002). Median survival for all patients and for resected patients in the CR and SF groups was, respectively, 15 months vs. 17 months, and 21 months vs. 18 months (P= non-significant).

Conclusions: Preoperative chemoradiation allows for good local control of the disease but does not increase survival, mainly for reasons of metastatic spread. Other options should be developed to improve both local and distant control of the disease.

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Figures

Figure 1
Figure 1
Flow chart showing patient treatment subgroups in the surgery-first and chemoradiation groups, RCT, radiochemotherapy
Figure 2
Figure 2
Survival curves for all patients and for resected and non-resected patients. The tables under each graph give the number at risk. (A) Overall survival. Median survival is 15 months (range: 3–72 months) in the chemoradiation (CR) group and 17 months (range: 1–109 months) in the surgery-first (SF) group. Three- and 5-year survival rates are, respectively, 10% (95% confidence interval [CI] 5.3–7.6) and 2% (95% CI 2.0–5.3) in the CR group, and 21% (95% CI 8.4–9.8) and 8% (95% CI 5.5–9.6) in the SF group. (B) Survival of resected patients. Median survival is 21.5 months (range: 5–72 months) in the CR group and 18 months (range: 2–109 months) in the SF group (non-significant). Three- and 5-year survival rates are, respectively, 15% (95% CI 9.4–13.7) and 3% (95% CI 2.8–10.2) in the CR group, and 26% (95% CI 10.2–11.4) and 10% (95% CI 6.9–11.6) in the SF group. (C) Survival of non-resected patients. Median survival is 13.5 months (range: 3–69 months) in the CR group and 10.5 months (range: 1–28 months) in the SF group (non-significant). Three- and 5-year survival rates are 2% (95% CI 1.8–7.2) in the CR group and 0% in the SF group. (D) Survival of patients with R0 vs. R1 margins. Median survival is 20 months (range: 2–109 months) in R0 patients and 14 months (range: 4–47 months) in R1 patients
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References

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