A multicenter study led by Vanderbilt University Institute for Medicine and Public Health investigators found that pancreatic cancer patients who underwent surgery and received chemotherapy lived longer and had fewer cancer recurrences in other parts of the body than patients who also received chemoradiation therapy.
[Photo: Dr. Alexander Parikh]
The study led by Dr. Alexander Parikh, associate professor of surgery and director of the Vanderbilt Pancreas Center, was published online February 16 in advance of print publication in the Journal of the American College of Surgeons. Dr. Parikh also presented the results in December 2015 at the Southern Surgical Association meeting in Hot Springs, Virginia.
Pancreatic cancer is the fourth most common cause of cancer death in the United States, with an estimated 48,960 new cases per year, according to the Centers for Disease Control and Prevention (CDC).
Most patients already have advanced disease at the time of diagnosis and only 10 to 15 percent of patients are eligible for surgery that may cure the disease. Even among surgery patients, 50 to 90 percent of patients have a recurrence of cancer and most die of the disease.
Because so many patients experience disease recurrence, six months of systemic chemotherapy following surgery is the standard of care, but some physicians add chemoradiation.
Investigators from the Central Pancreatic Consortium (CPC), a group of academic medical centers (including Vanderbilt) treating a high volume of pancreatic cancer patients, sought to determine whether chemoradiation therapy provides any additional advantage.
This study followed 1,130 patients from eight centers over a 10-year period from January 2000 to December 2010. The researchers assessed the patterns of disease recurrence among patients who had surgery alone, those who also received chemotherapy and those who had radiotherapy in addition to surgery and chemotherapy. Patients were followed for a median period of 18 months.
When controlling for several associated factors, adjuvant chemotherapy led to a 29 percent improvement in overall survival when compared to surgery alone while chemoradiation did not significantly improve survival. The incidence of local recurrence was significantly decreased by both chemotherapy (41 percent) and chemoradiation (49 percent). However, the incidence of distant recurrence was significantly lower only after chemotherapy (26 percent) and was not affected by chemoradiation.
The authors concluded that reducing both local and distant recurrence, therefore, will lead to improvements in overall survival and only adjuvant chemotherapy can accomplish this.
The authors recommended that future investigations should consider a longer period of chemotherapy alone rather than chemoradiation therapy, and if chemoradiation is used, it should not be at the expense of less systemic chemotherapy.