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Dose escalation of radiation therapy with or without induction chemotherapy for unresectable locally advanced pancreatic cancer
BACKGROUND: Dose escalation of conventionally fractionated radiation therapy (CFRT) above 45–54 Gy has an unclear survival benefit. Prior National Cancer Database (NCDB) analyses have shown improved overall survival with induction chemotherapy (iC) prior to concurrent chemoradiation (CRT) in locally...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6219058/ https://www.ncbi.nlm.nih.gov/pubmed/30400962 http://dx.doi.org/10.1186/s13014-018-1158-z |
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author | Ma, Sung Jun Prezzano, Kavitha M. Hermann, Gregory M. Singh, Anurag K. |
author_facet | Ma, Sung Jun Prezzano, Kavitha M. Hermann, Gregory M. Singh, Anurag K. |
author_sort | Ma, Sung Jun |
collection | PubMed |
description | BACKGROUND: Dose escalation of conventionally fractionated radiation therapy (CFRT) above 45–54 Gy has an unclear survival benefit. Prior National Cancer Database (NCDB) analyses have shown improved overall survival with induction chemotherapy (iC) prior to concurrent chemoradiation (CRT) in locally advanced pancreatic cancer. Our study compared dose-escalated CFRT with and without iC. METHODS: The NCDB was queried for primary stage III, cT4 N0–1 M0 LAPC treated with CRT with or without iC (2004–2015). CFRT was stratified by < 55 Gy and ≥ 55 Gy. Cohort iC + CRT and CRT included those with and without iC, respectively. The primary endpoint was overall survival (OS). Kaplan-Meier analysis, Cox proportional hazards method, and propensity score matching were used. RESULTS: Among 2029 patients, cohort iC + CRT had 738 patients (n = 601 for 45–55 Gy and n = 137 for ≥55 Gy) and cohort CRT had 1291 patients (n = 1066 for 45–55 Gy and n = 225 for ≥55 Gy). Median follow-up was 24.3 months and 24.6 months for cohorts iC + CRT and CRT, respectively. Dose escalation showed improved survival in the multivariable analysis in cohort iC + CRT (HR 0.77, p = 0.013) but not in cohort CRT (HR 0.91, p = 0.19). Using 2:1 propensity score matching, a total of 387 patients for cohort iC + CRT and 549 patients for cohort CRT were matched. After matching, dose escalation remained significant for improved overall survival in cohort iC + CRT (median OS 16.2 vs 15.2 months; 2-yr OS 33.4% vs 25.4%; p = 0.022) but not in cohort CRT (median OS 11.8 vs 10.6 months; 2-yr OS 13.3% vs 10.1%; p = 0.16). CONCLUSIONS: Patients with locally advanced pancreatic cancer who undergo iC have improved survival with radiation dose escalation above 55 Gy. For patients without iC, there is no clear association between radiation dose escalation and survival. |
format | Online Article Text |
id | pubmed-6219058 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-62190582018-11-08 Dose escalation of radiation therapy with or without induction chemotherapy for unresectable locally advanced pancreatic cancer Ma, Sung Jun Prezzano, Kavitha M. Hermann, Gregory M. Singh, Anurag K. Radiat Oncol Research BACKGROUND: Dose escalation of conventionally fractionated radiation therapy (CFRT) above 45–54 Gy has an unclear survival benefit. Prior National Cancer Database (NCDB) analyses have shown improved overall survival with induction chemotherapy (iC) prior to concurrent chemoradiation (CRT) in locally advanced pancreatic cancer. Our study compared dose-escalated CFRT with and without iC. METHODS: The NCDB was queried for primary stage III, cT4 N0–1 M0 LAPC treated with CRT with or without iC (2004–2015). CFRT was stratified by < 55 Gy and ≥ 55 Gy. Cohort iC + CRT and CRT included those with and without iC, respectively. The primary endpoint was overall survival (OS). Kaplan-Meier analysis, Cox proportional hazards method, and propensity score matching were used. RESULTS: Among 2029 patients, cohort iC + CRT had 738 patients (n = 601 for 45–55 Gy and n = 137 for ≥55 Gy) and cohort CRT had 1291 patients (n = 1066 for 45–55 Gy and n = 225 for ≥55 Gy). Median follow-up was 24.3 months and 24.6 months for cohorts iC + CRT and CRT, respectively. Dose escalation showed improved survival in the multivariable analysis in cohort iC + CRT (HR 0.77, p = 0.013) but not in cohort CRT (HR 0.91, p = 0.19). Using 2:1 propensity score matching, a total of 387 patients for cohort iC + CRT and 549 patients for cohort CRT were matched. After matching, dose escalation remained significant for improved overall survival in cohort iC + CRT (median OS 16.2 vs 15.2 months; 2-yr OS 33.4% vs 25.4%; p = 0.022) but not in cohort CRT (median OS 11.8 vs 10.6 months; 2-yr OS 13.3% vs 10.1%; p = 0.16). CONCLUSIONS: Patients with locally advanced pancreatic cancer who undergo iC have improved survival with radiation dose escalation above 55 Gy. For patients without iC, there is no clear association between radiation dose escalation and survival. BioMed Central 2018-11-06 /pmc/articles/PMC6219058/ /pubmed/30400962 http://dx.doi.org/10.1186/s13014-018-1158-z Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Ma, Sung Jun Prezzano, Kavitha M. Hermann, Gregory M. Singh, Anurag K. Dose escalation of radiation therapy with or without induction chemotherapy for unresectable locally advanced pancreatic cancer |
title | Dose escalation of radiation therapy with or without induction chemotherapy for unresectable locally advanced pancreatic cancer |
title_full | Dose escalation of radiation therapy with or without induction chemotherapy for unresectable locally advanced pancreatic cancer |
title_fullStr | Dose escalation of radiation therapy with or without induction chemotherapy for unresectable locally advanced pancreatic cancer |
title_full_unstemmed | Dose escalation of radiation therapy with or without induction chemotherapy for unresectable locally advanced pancreatic cancer |
title_short | Dose escalation of radiation therapy with or without induction chemotherapy for unresectable locally advanced pancreatic cancer |
title_sort | dose escalation of radiation therapy with or without induction chemotherapy for unresectable locally advanced pancreatic cancer |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6219058/ https://www.ncbi.nlm.nih.gov/pubmed/30400962 http://dx.doi.org/10.1186/s13014-018-1158-z |
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