Does preoperative therapy optimize outcomes in patients with resectable pancreatic cancer?

Katia T. Papalezova, Douglas Tyler, Dan G. Blazer, Bryan M. Clary, Brian G. Czito, Herbert I. Hurwitz, Hope E. Uronis, Theodore N. Pappas, Christopher G. Willett, Rebekah R. White

Research output: Contribution to journalArticle

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Abstract

The objective of this study was to compare survival between all patients with radiographically resectable adenocarcinoma of the proximal pancreas who underwent preoperative chemoradiation therapy (PRE-OP CRT) or surgical exploration first (SURGERY) with "intention to resect." Pancreatic cancer patients who undergo resection after PREOP CRT live longer than patients who undergo resection without PREOP CRT, a difference that may be attributable to patient selection. We retrospectively identified 236 patients with pancreatic head adenocarcinoma seen between 1999 and 2007 with sufficient data to be confirmed medically and radiographically resectable. The outcomes of 144 patients who underwent PREOP CRT were compared to those of 92 patients who proceeded straight to SURGERY. The groups were similar in age and gender. Tumors were slightly larger in the PREOP CRT group (mean 2.5 cm vs. 2.1 cm, P < 0.01), and there were trends toward more venous abutment (54% vs. 39%, P = 0.06) and a higher Charlson comorbidity index (P = 0.1). In the PREOP CRT group, 76 patients (53%) underwent resection, 28 (19%) had metastatic and 17 (12%) locally unresectable disease after PREOP CRT, and 23 (16%) were not explored due to performance status or loss to follow-up. In the SURGERY group, 68 patients (74%) underwent resection. Sixteen patients (17%) had metastatic and eight patients (9%) locally unresectable disease at exploration. In patients who underwent resection, the PREOP CRT group had smaller pathologic tumor size and lower incidence of positive lymph nodes than the SURGERY group but no difference in positive margins or need for vascular resection. Median overall survival (OS) in patients undergoing resection was 27 months in the PREOP CRT group and 17 months in the SURGERY group (P = 0.04). Median OS in all patients treated with PREOP CRT or surgically explored with intention to resect was 15 and 13 months, respectively, with superimposable survival curves. Despite a lower resection rate, the PREOP CRT group as a whole had a similar OS to the SURGERY group as a whole. For patients who underwent resection, those in the PREOP CRT had longer survival than those in the SURGERY group, suggesting that PREOP CRT allows better patient selection for resection. PREOP CRT should be considered an acceptable alternative for most patients with resectable pancreatic cancer.

Original languageEnglish (US)
Pages (from-to)111-118
Number of pages8
JournalJournal of Surgical Oncology
Volume106
Issue number1
DOIs
StatePublished - Jul 1 2012
Externally publishedYes

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Pancreatic Neoplasms
Therapeutics
Survival
Patient Selection
Adenocarcinoma
Blood Vessels
Comorbidity
Pancreas
Neoplasms
Lymph Nodes

Keywords

  • Cancer
  • Neoadjuvant
  • Pancreatic
  • Treatment

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Papalezova, K. T., Tyler, D., Blazer, D. G., Clary, B. M., Czito, B. G., Hurwitz, H. I., ... White, R. R. (2012). Does preoperative therapy optimize outcomes in patients with resectable pancreatic cancer? Journal of Surgical Oncology, 106(1), 111-118. https://doi.org/10.1002/jso.23044

Does preoperative therapy optimize outcomes in patients with resectable pancreatic cancer? / Papalezova, Katia T.; Tyler, Douglas; Blazer, Dan G.; Clary, Bryan M.; Czito, Brian G.; Hurwitz, Herbert I.; Uronis, Hope E.; Pappas, Theodore N.; Willett, Christopher G.; White, Rebekah R.

In: Journal of Surgical Oncology, Vol. 106, No. 1, 01.07.2012, p. 111-118.

Research output: Contribution to journalArticle

Papalezova, KT, Tyler, D, Blazer, DG, Clary, BM, Czito, BG, Hurwitz, HI, Uronis, HE, Pappas, TN, Willett, CG & White, RR 2012, 'Does preoperative therapy optimize outcomes in patients with resectable pancreatic cancer?', Journal of Surgical Oncology, vol. 106, no. 1, pp. 111-118. https://doi.org/10.1002/jso.23044
Papalezova, Katia T. ; Tyler, Douglas ; Blazer, Dan G. ; Clary, Bryan M. ; Czito, Brian G. ; Hurwitz, Herbert I. ; Uronis, Hope E. ; Pappas, Theodore N. ; Willett, Christopher G. ; White, Rebekah R. / Does preoperative therapy optimize outcomes in patients with resectable pancreatic cancer?. In: Journal of Surgical Oncology. 2012 ; Vol. 106, No. 1. pp. 111-118.
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