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. "Individual institutions may differ slightly in the way they treat pancreatic cancer patients. When we do a collective, multicenter study, we decrease those differences and can provide insights that reflect the majority of what good pancreatic cancer care in America is," he said.
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."
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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). The incidence of distant recurrence was significantly lower only after chemotherapy (26 percent). It was not affected by chemoradiation. "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 chemoradiotherapy, 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 chemoradiotherapy, it should not be given at the expense of giving less chemotherapy," he concluded.
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