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Multicenter Study
. 2023 Jun 10;30(6):5690-5703.
doi: 10.3390/curroncol30060427.

Comparative Effectiveness of Chemotherapy Alone Versus Radiotherapy-Based Regimens in Locally Advanced Pancreatic Cancer: A Real-World Multicenter Analysis (PAULA-1)

Alessandra Arcelli  1 , Giuseppe Tarantino  2 , Francesco Cellini  3   4 , Milly Buwenge  5 , Gabriella Macchia  6 , Federica Bertini  7 , Alessandra Guido  1 , Francesco Deodato  3   6 , Savino Cilla  8 , Valerio Scotti  9 , Maria Elena Rosetto  10 , Igor Djan  11 , Salvatore Parisi  12 , Gian Carlo Mattiucci  3   13 , Michele Fiore  14   15 , Pierluigi Bonomo  16 , Liliana Belgioia  17   18 , Rita Marina Niespolo  19 , Pietro Gabriele  20 , Mariacristina Di Marco  21 , Nicola Simoni  22 , Johnny Ma  1   5 , Lidia Strigari  23 , Renzo Mazzarotto  24 , Alessio Giuseppe Morganti  1   5
Affiliations
Multicenter Study

Comparative Effectiveness of Chemotherapy Alone Versus Radiotherapy-Based Regimens in Locally Advanced Pancreatic Cancer: A Real-World Multicenter Analysis (PAULA-1)

Alessandra Arcelli et al. Curr Oncol. .

Abstract

Different options for locally advanced pancreatic cancer (LAPC) are available based on international guidelines: chemotherapy (CHT), chemoradiation (CRT), and stereotactic body radiotherapy (SBRT). However, the role of radiotherapy is debated in LAPC. We retrospectively compared CHT, CRT, and SBRT ± CHT in a real-world setting in terms of overall survival (OS), local control (LC), and distant metastasis-free survival (DMFS). LAPC patients from a multicentric retrospective database were included (2005-2018). Survival curves were calculated using the Kaplan-Meier method. Multivariable Cox analysis was performed to identify predictors of LC, OS, and DMFS. Of the 419 patients included, 71.1% were treated with CRT, 15.5% with CHT, and 13.4% with SBRT. Multivariable analysis showed higher LC rates for CRT (HR: 0.56, 95%CI 0.34-0.92, p = 0.022) or SBRT (HR: 0.27, 95%CI 0.13-0.54, p < 0.001), compared to CHT. CRT (HR: 0.44, 95%CI 0.28-0.70, p < 0.001) and SBRT (HR: 0.40, 95%CI 0.22-0.74, p = 0.003) were predictors of prolonged OS with respect to CHT. No significant differences were recorded in terms of DMFS. In selected patients, the addition of radiotherapy to CHT is still an option to be considered. In patients referred for radiotherapy, CRT can be replaced by SBRT considering its duration, higher LC rate, and OS rate, which are at least comparable to that of CRT.

Keywords: chemoradiation; chemotherapy; conventionally fractionated radiotherapy; pancreatic cancer; stereotactic body radiotherapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Actuarial local control: comparison between chemoradiation (CRT), chemotherapy (CHT), and stereotactic body radiotherapy (SBRT).
Figure 2
Figure 2
Actuarial overall survival: comparison between chemoradiation (CRT), chemotherapy (CHT), and stereotactic body radiotherapy (SBRT).
See this image and copyright information in PMC

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