Pancreaticoduodenectomy for pancreatic adenocarcinoma: Postoperative adjuvant chemoradiation improves survival: A prospective, single-institution experience

Charles J. Yeo, Ross A. Abrams, Louise B. Grochow, Taylor A. Sohn, Sarah E. Ord, Ralph H. Hruban, Marianna L. Zahurak, William C. Dooley, JoAnn Coleman, Patricia K. Sauter, Henry A. Pitt, Keith D. Lilltemoe, John L. Cameron

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Abstract

Objective: This study was designed to evaluate prospectively survival after pancreaticoduodenectomy for pancreatic adenocarcinoma, comparing two different postoperative adjuvant chemoradiation protocols to those of no adjuvant therapy. Summary Background Data: Based on limited data from the Gastrointestinal Tumor Study Group, adjuvant chemoradiation therapy has been recommended after pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas. However, many patients continue to receive no such therapy. Methods: From October 1991 through September 1995, all patients with resected, pathologically confirmed adenocarcinoma of the head, neck, or uncinate process of the pancreas were reviewed by a multidisciplinary group (surgery, radiation oncology, medical oncology, and pathology) and were offered three options for postoperative treatment after pancreaticoduodenectomy: 1) standard therapy: external beam radiation therapy to the pancreatic bed (4000-4500 cGy) given with two 3-day fluorouracil (5- FU) courses and followed by weekly bolus 5-FU (500 mg/m2 per day) for 4 months; 2) intensive therapy: external beam radiation therapy to the pancreatic bed (5040-5760 cGy) with prophylactic hepatic irradiation (2340- 2700 cGy) given with and followed by infusional 5-FU (200 mg/m2 per day) plus leucovorin (5 mg/m2 per day) for 5 of 7 days for 4 months; or 3) no therapy: no postoperative radiation therapy or chemotherapy. Results: Pancreaticoduodenectomy was performed in 174 patients, with 1 in-hospital death (0.6%). Ninety-nine patients elected standard therapy, 21 elected intensive therapy, and 53 patients declined therapy. The three groups were comparable with respect to race, gender, intraoperative blood loss, tumor differentiation, lymph node status, tumor diameter, and resection margin status. Univariate analyses indicated that tumor diameter <3 cm, intraoperative blood loss <700 mL, absence of intraoperative blood transfusions, and use of adjuvant chemoradiation therapy were associated with significantly longer survival (p < 0.05). By Cox proportional hazards survival analysis, the most powerful predictors of outcome were tumor diameter, intraoperative blood loss, status of resection margins, and use of postoperative adjuvant therapy. The use of postoperative adjuvant chemoradiation therapy was a predictor of improved survival (median survival, 19.5 months compared to 13.5 months without therapy; p = 0.003). The intensive therapy group had no survival advantage when compared to that of the standard therapy group (median survival, 17.5 months vs. 21 months, p = not significant). Conclusions: Adjuvant chemoradiation therapy significantly improves survival after pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas. Based on these survival data, standard adjuvant chemoradiation therapy appears to be indicated for patients treated by pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas. Intensive therapy conferred no survival advantage over standard therapy in this analysis.

Original languageEnglish (US)
Pages (from-to)621-636
Number of pages16
JournalAnnals of Surgery
Volume225
Issue number5
DOIs
StatePublished - 1997
Externally publishedYes

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Pancreaticoduodenectomy
Adenocarcinoma
Survival
Therapeutics
Fluorouracil
Pancreas
Neck
Head
Radiotherapy
Neoplasms
Group Psychotherapy
Radiation Oncology
Medical Oncology
Leucovorin

ASJC Scopus subject areas

  • Surgery

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Pancreaticoduodenectomy for pancreatic adenocarcinoma : Postoperative adjuvant chemoradiation improves survival: A prospective, single-institution experience. / Yeo, Charles J.; Abrams, Ross A.; Grochow, Louise B.; Sohn, Taylor A.; Ord, Sarah E.; Hruban, Ralph H.; Zahurak, Marianna L.; Dooley, William C.; Coleman, JoAnn; Sauter, Patricia K.; Pitt, Henry A.; Lilltemoe, Keith D.; Cameron, John L.

In: Annals of Surgery, Vol. 225, No. 5, 1997, p. 621-636.

Research output: Contribution to journalArticle

Yeo, CJ, Abrams, RA, Grochow, LB, Sohn, TA, Ord, SE, Hruban, RH, Zahurak, ML, Dooley, WC, Coleman, J, Sauter, PK, Pitt, HA, Lilltemoe, KD & Cameron, JL 1997, 'Pancreaticoduodenectomy for pancreatic adenocarcinoma: Postoperative adjuvant chemoradiation improves survival: A prospective, single-institution experience', Annals of Surgery, vol. 225, no. 5, pp. 621-636. https://doi.org/10.1097/00000658-199705000-00018
Yeo, Charles J. ; Abrams, Ross A. ; Grochow, Louise B. ; Sohn, Taylor A. ; Ord, Sarah E. ; Hruban, Ralph H. ; Zahurak, Marianna L. ; Dooley, William C. ; Coleman, JoAnn ; Sauter, Patricia K. ; Pitt, Henry A. ; Lilltemoe, Keith D. ; Cameron, John L. / Pancreaticoduodenectomy for pancreatic adenocarcinoma : Postoperative adjuvant chemoradiation improves survival: A prospective, single-institution experience. In: Annals of Surgery. 1997 ; Vol. 225, No. 5. pp. 621-636.
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abstract = "Objective: This study was designed to evaluate prospectively survival after pancreaticoduodenectomy for pancreatic adenocarcinoma, comparing two different postoperative adjuvant chemoradiation protocols to those of no adjuvant therapy. Summary Background Data: Based on limited data from the Gastrointestinal Tumor Study Group, adjuvant chemoradiation therapy has been recommended after pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas. However, many patients continue to receive no such therapy. Methods: From October 1991 through September 1995, all patients with resected, pathologically confirmed adenocarcinoma of the head, neck, or uncinate process of the pancreas were reviewed by a multidisciplinary group (surgery, radiation oncology, medical oncology, and pathology) and were offered three options for postoperative treatment after pancreaticoduodenectomy: 1) standard therapy: external beam radiation therapy to the pancreatic bed (4000-4500 cGy) given with two 3-day fluorouracil (5- FU) courses and followed by weekly bolus 5-FU (500 mg/m2 per day) for 4 months; 2) intensive therapy: external beam radiation therapy to the pancreatic bed (5040-5760 cGy) with prophylactic hepatic irradiation (2340- 2700 cGy) given with and followed by infusional 5-FU (200 mg/m2 per day) plus leucovorin (5 mg/m2 per day) for 5 of 7 days for 4 months; or 3) no therapy: no postoperative radiation therapy or chemotherapy. Results: Pancreaticoduodenectomy was performed in 174 patients, with 1 in-hospital death (0.6{\%}). Ninety-nine patients elected standard therapy, 21 elected intensive therapy, and 53 patients declined therapy. The three groups were comparable with respect to race, gender, intraoperative blood loss, tumor differentiation, lymph node status, tumor diameter, and resection margin status. Univariate analyses indicated that tumor diameter <3 cm, intraoperative blood loss <700 mL, absence of intraoperative blood transfusions, and use of adjuvant chemoradiation therapy were associated with significantly longer survival (p < 0.05). By Cox proportional hazards survival analysis, the most powerful predictors of outcome were tumor diameter, intraoperative blood loss, status of resection margins, and use of postoperative adjuvant therapy. The use of postoperative adjuvant chemoradiation therapy was a predictor of improved survival (median survival, 19.5 months compared to 13.5 months without therapy; p = 0.003). The intensive therapy group had no survival advantage when compared to that of the standard therapy group (median survival, 17.5 months vs. 21 months, p = not significant). Conclusions: Adjuvant chemoradiation therapy significantly improves survival after pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas. Based on these survival data, standard adjuvant chemoradiation therapy appears to be indicated for patients treated by pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas. Intensive therapy conferred no survival advantage over standard therapy in this analysis.",
author = "Yeo, {Charles J.} and Abrams, {Ross A.} and Grochow, {Louise B.} and Sohn, {Taylor A.} and Ord, {Sarah E.} and Hruban, {Ralph H.} and Zahurak, {Marianna L.} and Dooley, {William C.} and JoAnn Coleman and Sauter, {Patricia K.} and Pitt, {Henry A.} and Lilltemoe, {Keith D.} and Cameron, {John L.}",
year = "1997",
doi = "10.1097/00000658-199705000-00018",
language = "English (US)",
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TY - JOUR

T1 - Pancreaticoduodenectomy for pancreatic adenocarcinoma

T2 - Postoperative adjuvant chemoradiation improves survival: A prospective, single-institution experience

AU - Yeo, Charles J.

AU - Abrams, Ross A.

AU - Grochow, Louise B.

AU - Sohn, Taylor A.

AU - Ord, Sarah E.

AU - Hruban, Ralph H.

AU - Zahurak, Marianna L.

AU - Dooley, William C.

AU - Coleman, JoAnn

AU - Sauter, Patricia K.

AU - Pitt, Henry A.

AU - Lilltemoe, Keith D.

AU - Cameron, John L.

PY - 1997

Y1 - 1997

N2 - Objective: This study was designed to evaluate prospectively survival after pancreaticoduodenectomy for pancreatic adenocarcinoma, comparing two different postoperative adjuvant chemoradiation protocols to those of no adjuvant therapy. Summary Background Data: Based on limited data from the Gastrointestinal Tumor Study Group, adjuvant chemoradiation therapy has been recommended after pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas. However, many patients continue to receive no such therapy. Methods: From October 1991 through September 1995, all patients with resected, pathologically confirmed adenocarcinoma of the head, neck, or uncinate process of the pancreas were reviewed by a multidisciplinary group (surgery, radiation oncology, medical oncology, and pathology) and were offered three options for postoperative treatment after pancreaticoduodenectomy: 1) standard therapy: external beam radiation therapy to the pancreatic bed (4000-4500 cGy) given with two 3-day fluorouracil (5- FU) courses and followed by weekly bolus 5-FU (500 mg/m2 per day) for 4 months; 2) intensive therapy: external beam radiation therapy to the pancreatic bed (5040-5760 cGy) with prophylactic hepatic irradiation (2340- 2700 cGy) given with and followed by infusional 5-FU (200 mg/m2 per day) plus leucovorin (5 mg/m2 per day) for 5 of 7 days for 4 months; or 3) no therapy: no postoperative radiation therapy or chemotherapy. Results: Pancreaticoduodenectomy was performed in 174 patients, with 1 in-hospital death (0.6%). Ninety-nine patients elected standard therapy, 21 elected intensive therapy, and 53 patients declined therapy. The three groups were comparable with respect to race, gender, intraoperative blood loss, tumor differentiation, lymph node status, tumor diameter, and resection margin status. Univariate analyses indicated that tumor diameter <3 cm, intraoperative blood loss <700 mL, absence of intraoperative blood transfusions, and use of adjuvant chemoradiation therapy were associated with significantly longer survival (p < 0.05). By Cox proportional hazards survival analysis, the most powerful predictors of outcome were tumor diameter, intraoperative blood loss, status of resection margins, and use of postoperative adjuvant therapy. The use of postoperative adjuvant chemoradiation therapy was a predictor of improved survival (median survival, 19.5 months compared to 13.5 months without therapy; p = 0.003). The intensive therapy group had no survival advantage when compared to that of the standard therapy group (median survival, 17.5 months vs. 21 months, p = not significant). Conclusions: Adjuvant chemoradiation therapy significantly improves survival after pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas. Based on these survival data, standard adjuvant chemoradiation therapy appears to be indicated for patients treated by pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas. Intensive therapy conferred no survival advantage over standard therapy in this analysis.

AB - Objective: This study was designed to evaluate prospectively survival after pancreaticoduodenectomy for pancreatic adenocarcinoma, comparing two different postoperative adjuvant chemoradiation protocols to those of no adjuvant therapy. Summary Background Data: Based on limited data from the Gastrointestinal Tumor Study Group, adjuvant chemoradiation therapy has been recommended after pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas. However, many patients continue to receive no such therapy. Methods: From October 1991 through September 1995, all patients with resected, pathologically confirmed adenocarcinoma of the head, neck, or uncinate process of the pancreas were reviewed by a multidisciplinary group (surgery, radiation oncology, medical oncology, and pathology) and were offered three options for postoperative treatment after pancreaticoduodenectomy: 1) standard therapy: external beam radiation therapy to the pancreatic bed (4000-4500 cGy) given with two 3-day fluorouracil (5- FU) courses and followed by weekly bolus 5-FU (500 mg/m2 per day) for 4 months; 2) intensive therapy: external beam radiation therapy to the pancreatic bed (5040-5760 cGy) with prophylactic hepatic irradiation (2340- 2700 cGy) given with and followed by infusional 5-FU (200 mg/m2 per day) plus leucovorin (5 mg/m2 per day) for 5 of 7 days for 4 months; or 3) no therapy: no postoperative radiation therapy or chemotherapy. Results: Pancreaticoduodenectomy was performed in 174 patients, with 1 in-hospital death (0.6%). Ninety-nine patients elected standard therapy, 21 elected intensive therapy, and 53 patients declined therapy. The three groups were comparable with respect to race, gender, intraoperative blood loss, tumor differentiation, lymph node status, tumor diameter, and resection margin status. Univariate analyses indicated that tumor diameter <3 cm, intraoperative blood loss <700 mL, absence of intraoperative blood transfusions, and use of adjuvant chemoradiation therapy were associated with significantly longer survival (p < 0.05). By Cox proportional hazards survival analysis, the most powerful predictors of outcome were tumor diameter, intraoperative blood loss, status of resection margins, and use of postoperative adjuvant therapy. The use of postoperative adjuvant chemoradiation therapy was a predictor of improved survival (median survival, 19.5 months compared to 13.5 months without therapy; p = 0.003). The intensive therapy group had no survival advantage when compared to that of the standard therapy group (median survival, 17.5 months vs. 21 months, p = not significant). Conclusions: Adjuvant chemoradiation therapy significantly improves survival after pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas. Based on these survival data, standard adjuvant chemoradiation therapy appears to be indicated for patients treated by pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas. Intensive therapy conferred no survival advantage over standard therapy in this analysis.

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