Ann Surg 2007 Nov
Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891.
ABSTRACT
BACKGROUND
The role of adjuvant chemoradiation in pancreatic cancer remains unclear. This report presents the long-term follow-up results of EORTC trial 40891, which assessed the role of chemoradiation in resectable pancreatic cancer.
METHODS
Two hundred eighteen patients were randomized after resection of the primary tumor. Eligible patients had T1-2 N0-N1a M0 pancreatic cancer or T1-3 N0-N1a M0 periampullary cancers, all histologic proven. Patients in the treatment group (n = 110) underwent postoperative chemoradiation (40 Gy plus 5-FU). Patients in the control group (n = 108) had no further adjuvant treatment.
FINDINGS
After a median follow-up of 11.7 years, 173 deaths (79%) have been reported. The overall survival did not differ between the 2 treatment groups (Chemoradiation treatment vs.
CONTROLS
death rate ratio 0.91, 95% CI: 0.68-1.23, P value 0.54). The 10-year overall survival was 18% in the whole population of patients (8% in the pancreatic head cancer group and 29% in the periampullary cancer group).
INTERPRETATION
These results confirm the previous short-term analysis, indicating no benefit of adjuvant chemoradiation over observation in patients with resected pancreatic cancer or periampullary cancer. Patients with pancreatic cancer may survive more than 10 years. Only 1 of 31 cases recurred after year 7.
Related Questions
What are the targets (tumor bed, positive margin, nodes etc.)?
New comment by Radiation Oncologist at St. Barnabas Medical Center ( November 14, 2015)
In a patient who received neoadjuvant chemo followed by chemoRT to 36 Gy/15 fractions, with a positive SMA margin at surgery (in field), would you offer an RT boost? If yes, h...
I can't convince the surgeons to refer their patients for adjuvant RT because the prospective data is messy and doesn’t seem to indicate a benef...
New comment by Radiation Oncologist at Memorial Sloan-Kettering Cancer Center ( July 8, 2023)
I only use respiratory motion management when there is a nearby GI luminal structure whose tolerance may be exceeded. So, my answer is that it depends on the anatomy. The posi...