Adjuvant radiotherapy and chemotherapy improve survival in patients with pancreatic adenocarcinoma receiving surgery: adjuvant chemotherapy alone is insufficient in the era of intensity modulation radiation therapy

Abstract

In the era of intensity modulation radiation therapy (IMRT), no prospective randomized trial has evaluated the efficacy of adjuvant therapies such as adjuvant concurrent chemoradiotherapy (CCRT), adjuvant sequential chemotherapy and radiotherapy (CT‐RT), and adjuvant CT alone in resectable pancreatic adenocarcinoma (PA). Through propensity score matching, we designed a nationwide, population‐based, head‐to‐head cohort study to determine the effects of dissimilar adjuvant treatments on resectable PA. We minimized the confounding of various adjuvant treatment outcomes among the following resectable PA groups of patients from the Taiwan Cancer Registry database: group 1, adjuvant CCRT; group 2, adjuvant sequential CT‐RT; and group 3, adjuvant CT alone. All the studied techniques are IMRTs. The matching process yielded a final cohort of 588 patients (196, 196, and 196 patients in groups 1, 2, and 3, respectively). In both univariate and multivariate Cox regression analyses, adjusted hazard ratios (aHRs; 95% confidence interval [CI]) of death derived for the adjuvant CCRT and adjuvant sequential CT‐RT cohorts compared with the adjuvant CT alone cohort were 0.398 (0.314–0.504) and 0.307 (0.235–0.402), respectively. A combination of adjuvant IMRT and CT for resectable PA treatment improves survival to a greater extent than does adjuvant CT alone.

Prognostic factors following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

“…2 Others reported that a combination of CTx and radiotherapy was the most significant positive prognostic factor for survival. 5,26,27 In this study, we had 4.3% perioperative mortality which is nearly similar to what was reported in other studies. 2,4,6,13,21,28 Seppänen et al, reported perioperative mortality 2.1%, and 5-year survival 22% after PD for PDAC.…”

Effect of marital status on survival in glioblastoma multiforme by demographics, education, economic factors, and insurance status

“…PSM has been widely used in several areas of medical research including studies to assess factors associated with cancer survival 25, 26, 27, 28, 29. In our study, after 1:1 matching, married patients showed survival advantage over unmarried patients.…”

Differentiation of atypical pancreatic neuroendocrine tumors from pancreatic ductal adenocarcinomas: Using whole‐tumor CT texture analysis as quantitative biomarkers

“…Accurate preoperative differentiation between pNET and PDAC is crucial not only for selecting more suitable treatment but patient prognosis . For pNET patients, previous studies have reported that more aggressive surgery method could lead to higher morbidity and did not significantly improve overall survival compared with conservative resections .…”