Microscopic Margins and Patterns of Treatment Failure in Resected Pancreatic Adenocarcinoma

Gnerlich, Jennifer L.; Luka, S.; Deshpande, Ashwini; DuBray, Bernard J.; Weir, Joshua; Carpenter, Danielle; Brunt, Elizabeth M.; Strasberg, Steven M.; Hawkins, William G.; Linehan, David C.

doi:10.1001/archsurg.2012.1126

Cited by 130 publications

(124 citation statements)

References 46 publications

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“…This is likely mediated by the greater importance of local recurrence risk reduction after R1 resection because of the association of margin positivity and more frequent local recurrence. 22,23 In addition, CT alone may be ineffective for patients with R1 resection. 24 CRT was also associated with a reduction in the risk of death of approximately 15% among node-positive patients, despite a heightened risk of distant recurrence and the effectiveness of CT alone in this group.…”

Section: Discussionmentioning

confidence: 99%

Addition of radiotherapy to adjuvant chemotherapy is associated with improved overall survival in resected pancreatic adenocarcinoma: An analysis of the National Cancer Data Base

Rutter

Park

Corso

et al. 2015

Cancer

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BACKGROUND:The optimal treatment for resected pancreatic cancer is controversial because direct comparisons of adjuvant chemotherapy (CT) alone and chemotherapy and radiotherapy (CRT) are limited. This study assessed outcomes of CT versus CRT in a national cohort to provide a modern estimate of comparative effectiveness. METHODS: Patients with pT1-3N0-1M0 pancreatic adenocarcinoma after pancreatectomy were identified in the National Cancer Data Base. Overall survival (OS) was compared for CT and CRT groups with Cox regression and propensity score matching. Subset analyses by clinicopathologic characteristics were performed. RESULTS: This study identified 6165 patients treated with CT (n 5 2334 or 38%) or CRT (n 5 3831 or 62%). Most were classified as pT3 (72%), pN1 (67%), and status-post R0 resection (84%). For CRT patients, the median radiotherapy dose was 50.4 Gy. Compared with CT, CRT was associated with improved OS in a univariate analysis (median, 20.0 vs 22.3 months; at 5 years, 16.5% vs 19.6%; P <.001) and a multivariate analysis (hazard ratio [HR], 0.893; 95% confidence interval [CI], 0.837-0.953; P 5.001). CRT remained associated with improved OS after propensity score matching (HR, 0.851; 95% CI, 0.793-0.913; P <.001). Subset analyses showed that CRT was associated with improved OS among patients with pT3 (HR, 0.892; 95% CI, 0.828-0.962; P 5.003) or pN1 disease (HR, 0.856; 95% CI, 0.793-0.924; P <.001) and both R0 resection (HR, 0.901; 95% CI, 0.839-0.969; P 5.005) and R1 resection (HR, 0.842; 95% CI, 0.722-0.983; P 5.030). CONCLUSIONS: CRT was independently associated with improved OS after the resection of pancreatic adenocarcinoma in a large national cohort and particularly among patients with R1 resection and pN1 disease. Well-designed randomized comparisons of CRT and CT are urgently needed. Cancer 2015;121:4141-9.

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Section: Discussionmentioning

confidence: 99%

Addition of radiotherapy to adjuvant chemotherapy is associated with improved overall survival in resected pancreatic adenocarcinoma: An analysis of the National Cancer Data Base

Rutter

Park

Corso

et al. 2015

Cancer

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“…Rates of recurrence can be high, ranging from 50 % to 87 % of patients, even after resection with curative intent [31][32][33]. Adjuvant chemotherapy with gemcitabine has been shown to significantly increase overall survival and disease-specific survival in pancreatic cancer patients after resection compared to observation alone, although this increase in overall survival is seen to be only 2 months [34].…”

Section: Resultsmentioning

confidence: 99%

Beyond the Whipple Operation: Radical Resections for Cancers of the Head of the Pancreas

Schoellhammer

Goldner

Kim

et al. 2013

Indian J Surg Oncol

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Pancreatic adenocarcinoma is the most common pancreatic malignancy, and it occurs most commonly in the pancreatic head. It has a relatively low incidence; however it is a deadly disease and is the fourth most common cause of cancer deaths for males and females in the United States. Surgical resection in the form of pancreaticoduodenectomy is the mainstay of treatment and can lead to improved overall survival as well as the possibility of a cure, although only 10 % of patients are resectable at presentation. In an attempt to improve outcomes and survival, surgeons over the decades have employed various aggressive resectional strategies to combat this disease. In this paper we review the development of pancreaticoduodenectomy and touch on the role played by the American surgeon Allan Whipple in this development. We review modern data regarding radical pancreaticoduodenectomy and extended lymphadenectomy for pancreatic head cancers, as well as data and controversies regarding arterial and venous resection performed during the course of pancreaticoduodenectomy. The role of extended and vascular resections in the treatment of pancreatic neuroendocrine tumors in contrast to adenocarcinomas is also examined. We summarize the current state of data regarding radical pancreaticoduodenectomy and discuss pushing the boundaries of surgical resection to help improve outcomes for select groups of patients.

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“…Additionally, there appeared to be a large number of patients who developed distant metastases, most commonly in the liver. Given most distant metastases occurred synchronously with local recurrence, it is possible that these tumors were more biologically aggressive or that the development of locoregional failure facilitates distant metastases development (23)(24)(25). This concept suggests that improved LC, through addition of radiation therapy, may potentially prevent both local and subsequent distant recurrences.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Failure for Stage I Ampulla of Vater Adenocarcinoma: A Single Institutional Experience

Zhong¹,

Palta²,

Willett³

et al. 2013

International Journal of Radiation Oncology*Biology*Physics

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Microscopic Margins and Patterns of Treatment Failure in Resected Pancreatic Adenocarcinoma

Cited by 130 publications

References 46 publications

Addition of radiotherapy to adjuvant chemotherapy is associated with improved overall survival in resected pancreatic adenocarcinoma: An analysis of the National Cancer Data Base

Addition of radiotherapy to adjuvant chemotherapy is associated with improved overall survival in resected pancreatic adenocarcinoma: An analysis of the National Cancer Data Base

Beyond the Whipple Operation: Radical Resections for Cancers of the Head of the Pancreas

Patterns of Failure for Stage I Ampulla of Vater Adenocarcinoma: A Single Institutional Experience

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