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Neoadjuvant Chemoradiation and Duration of Chemotherapy Before Surgical Resection for Pancreatic Cancer: Does Time Interval Between Radiotherapy and Surgery Matter?

  • Pancreatic Tumors
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Abstract

Background

Neoadjuvant chemoradiation and chemotherapy provided for borderline or locally advanced, potentially resectable pancreatic adenocarcinoma improves resectability rates. Response to therapy is also an important prognostic factor. There are no data in the literature regarding optimal time interval or duration of chemotherapy after chemoradiation before surgery, and pathologic response rates. Using our database, we evaluated these relationships and the effect on overall and progression-free survival.

Methods

We retrospectively analyzed the records of 83 patients who underwent neoadjuvant chemoradiation for locally advanced, potentially resectable, and borderline resectable pancreatic cancers before definitive resection. We divided patients into three groups according to time interval between completion of chemoradiation and resection: group A (0–10 weeks), group B (11–20 weeks), and group C (>20 weeks). After chemoradiation, patients underwent ongoing chemotherapy before resection. Pathologic response was defined as major (>95 % fibrosis), partial (50–94 % fibrosis), or minor (<50 % fibrosis).

Results

There were 56 patients in group A, 17 patients in group B, and 10 patients in group C. Patients in groups B and C were significantly more likely to experience a major response than group A (p < 0.013). Patients in group C had significantly increased median progression-free and overall survival (p < 0.05). Multivariable classification and regression tree analysis demonstrated pathologic response to be the only significant factor in overall survival.

Conclusions

Patients who underwent a prolonged time interval after neoadjuvant chemoradiation with ongoing chemotherapy were more likely to have an improved pathologic response at time of surgical resection, which was associated with improved median overall survival.

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DISCLOSURE

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Kathryn T. Chen MD & John P. Hoffman MD

  2. Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA

    Karthik Devarajan PhD

  3. Department of Diagnostic Imaging, Fox Chase Cancer Center, Philadelphia, PA, USA

    Barton N. Milestone MD

  4. Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Harry S. Cooper MD

  5. Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Crystal Denlinger MD & Steven J. Cohen MD

  6. Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Joshua E. Meyer MD

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  1. Kathryn T. Chen MD
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  2. Karthik Devarajan PhD
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  3. Barton N. Milestone MD
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Correspondence to Kathryn T. Chen MD.

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Chen, K.T., Devarajan, K., Milestone, B.N. et al. Neoadjuvant Chemoradiation and Duration of Chemotherapy Before Surgical Resection for Pancreatic Cancer: Does Time Interval Between Radiotherapy and Surgery Matter?. Ann Surg Oncol 21, 662–669 (2014). https://doi.org/10.1245/s10434-013-3396-5

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  • DOI: https://doi.org/10.1245/s10434-013-3396-5

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