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Chemo better option following pancreatic cancer surgery: study

February 25, 2016 | Dagny Stuart

A multicenter study led by Vanderbilt University Medical Center (VUMC) investigators found that pancreatic cancer patients who underwent surgery and received chemotherapy lived longer and had fewer cancer recurrences in other parts of the body than patients who also received chemoradiation therapy.

The study led by Alexander Parikh, M.D., MPH, associate professor of Surgery and director of the Vanderbilt Pancreas Center, was published online Feb. 16 in advance of print publication in the Journal of the American College of Surgeons.

Alexander Parikh

Alexander Parikh, M.D., MPH

Parikh also presented the results in December 2015 at the Southern Surgical Association meeting in Hot Springs, Virginia.

Pancreatic cancer is the fourth most common cause of cancer death in the United States, with an estimated 48,960 new cases per year, according to the Centers for Disease Control and Prevention (CDC).

Most patients already have advanced disease at the time of diagnosis and only 10 to 15 percent of patients are eligible for surgery that may cure the disease. Even among surgery patients, 50 to 90 percent of patients have a recurrence of cancer and most die of the disease.

Because so many patients experience disease recurrence, six months of systemic chemotherapy following surgery is the standard of care, but some physicians add chemoradiation.

Investigators from the Central Pancreatic Consortium (CPC), a group of academic medical centers (including Vanderbilt) treating a high volume of pancreatic cancer patients, sought to determine whether chemoradiation therapy provides any additional advantage.

This study followed 1,130 patients from eight centers over a 10-year period from January 2000 to December 2010. The researchers assessed the patterns of disease recurrence among patients who had surgery alone, those who also received chemotherapy and those who had radiotherapy in addition to surgery and chemotherapy. Patients were followed for a median period of 18 months.

“The goal was to determine how adjuvant therapy affects disease recurrence,” Parikh said.

When controlling for several associated factors, adjuvant chemotherapy led to a 29 percent improvement in overall survival when compared to surgery alone while chemoradiation did not significantly improve survival. The incidence of local recurrence was significantly decreased by both chemotherapy (41 percent) and chemoradiation (49 percent). However, the incidence of distant recurrence was significantly lower only after chemotherapy (26 percent) and was not affected by chemoradiation.

The authors concluded that reducing both local and distant recurrence, therefore, will lead to improvements in overall survival and only adjuvant chemotherapy can accomplish this.

“We treat a high volume of patients with pancreatic cancer here at Vanderbilt, so it is crucial to provide treatment based on the best scientific information. 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,” Parikh said.

The authors recommended that future investigations should consider a longer period of chemotherapy alone rather than chemoradiation therapy, and if chemoradiation is used, it should not be at the expense of less systemic chemotherapy.

Study co-authors include Amelia Maiga, M.D., MPH, and Kamran Idrees, M.D., Vanderbilt; David Bentrem, M.D., Northwestern University, Evanston, Illinois; Malcolm Squires III, M.D., David Kooby, M.D., and Shishir Maithel, M.D., Emory University, Atlanta; Sharon Weber, M.D., and Clifford Cho, M.D., University of Wisconsin; Matthew Katz, M.D., M.D. Anderson Cancer Center, Houston; Robert Martin, M.D., Ph.D., and Charles Scoggins, M.D., University of Louisville; Jeff Sutton, M.D., Syed Ahmad, M.D., and Daniel Abbott, M.D., University of Cincinnati; Jacquelyn Carr, M.D., and Hong Jin Kim, M.D., University of North Carolina; Danny Yakoub, M.D., Ph.D. and Nipun Merchant, M.D., University of Miami.