Should pancreatic cancer patients receive adjuvant chemotherapy?18 Feb 2016
Patients who received chemotherapy after surgical resection of pancreatic cancer have fewer distant disease recurrences and longer overall survival than those who also had adjuvant chemo-radiation therapy. While a course of radiotherapy in addition to chemotherapy and a cancer operation reduced the number of local disease recurrences, it did not affect distant recurrences or survival.
Findings from the first multicenter clinical trial to relate disease recurrence patterns to the type of adjuvant therapy indicate that patients should receive a full course of chemotherapy rather than chemo-radiotherapy following surgical treatment for pancreatic cancer.
The study included more than 1,000 patients
The study evaluated survival and disease recurrence in 1,130 patients who underwent successful surgical resection for pancreatic cancer between January 2000 and December 2010. Most patients had grade 2, Stage II disease (grade 4, Stage IV is the most advanced), and they received no treatment for cancer prior to surgery. Alexander A. Parikh, MD, MPH, FACS, Associate Professor of Surgery at Vanderbilt University, Nashville, Tenn., led the study.
The researchers assessed the patterns of disease recurrence in three groups of patients:
- those who underwent a surgical procedure alone,
- those who had adjuvant chemotherapy, and
- those who had radiotherapy in addition to chemotherapy.
Patients were followed for a median period of 18 months. Dr. Parikh explained that a previous study by CPC a few years ago found that radiotherapy did not affect survival in certain groups of patients. "The goal here was to determine how adjuvant therapy affects disease recurrence."
An innovative study
Because of the high incidence of disease recurrence, adjuvant therapy is given routinely after surgery for pancreatic cancer. Adjuvant therapy typically involves systemic chemotherapy given with or without chemo-radiotherapy. A six-month course of chemotherapy is considered to be standard. The role of adjuvant chemo-radiation, however, is often used at the discretion of the treating physician, and is usually recommended for patients who have signs of local disease advancement, such as positive lymph nodes or positive surgical margins.
Dr. Parikh noted that this study is the first to examine the relationship between adjuvant chemotherapy and chemotherapy plus radiation on the patterns of disease recurrence and overall survival after primary surgical resection of pancreatic cancer. It was conducted by the Central Pancreatic Consortium (CPC), which includes nine academic medical centers that treat high volumes of patients with pancreatic cancer.
Clinical results: improvement in overall survival
When controlling for several associated factors, adjuvant chemotherapy led to a 29% improvement in overall survival when compared to surgery alone while chemo-radiation did not significantly improve survival. The incidence of local recurrence was significantly decreased by both chemotherapy (41%) and chemo-radiation (49%). The incidence of distant recurrence was significantly lower only after chemotherapy (26%). It was not affected by chemo-radiation. "Unless we get better evidence to show that radiation helps in resected pancreatic cancer, we believe adjuvant therapy should be confined to chemotherapy after surgery," Dr. Parikh said.
Dr. Parikh pointed out that while delivering adjuvant chemo-radiotherapy, physicians significantly reduce the amount of chemotherapy that is administered. "All patients should get at least six months of chemotherapy. If there is a role for chemo-radiotherapy, it should not be given at the expense of giving less chemotherapy," he concluded.Source: Medical News Today