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Survival benefit of adjuvant chemoradiotherapy for positive or close resection margin after curative resection of pancreatic adenocarcinoma
- Title
- Survival benefit of adjuvant chemoradiotherapy for positive or close resection margin after curative resection of pancreatic adenocarcinoma
- Authors
- Kim B.H.; Kim K.; Jang J.-Y.; Kwon W.; Kim H.; Lee K.-H.; Oh D.-Y.; Lee K.B.; Chie E.K.
- Ewha Authors
- 김규보
- SCOPUS Author ID
- 김규보
- Issue Date
- 2020
- Journal Title
- European Journal of Surgical Oncology
- ISSN
- 0748-7983
- Citation
- European Journal of Surgical Oncology vol. 46, no. 11, pp. 2122 - 2130
- Keywords
- Adjuvant chemoradiotherapy; Pancreatic cancer; Radiation dose; Resection margin
- Publisher
- W.B. Saunders Ltd
- Indexed
- SCIE; SCOPUS
- Document Type
- Article
- Abstract
- Background: This study was conducted to identify patients who may benefit from adjuvant chemoradiotherapy (CRT) for positive or close resection margin (RM) after curative resection of pancreatic adenocarcinoma. Methods: From 2004 to 2015, total of 472 patients with pancreatic adenocarcinoma underwent curative resection. After excluding patients with RM > 2 mm or unknown, remaining 217 patients were retrospectively analyzed. Forty-six (21.2%) patients were treated with adjuvant chemotherapy alone (CTx; mainly gemcitabine-based), 142 (65.4%) with adjuvant CRT (mainly upfront), and 29 (13.4%) patients didn't receive any adjuvant therapy (noTx group). Results: Locoregional recurrence rate was significantly lower in the CRT group (43.7%) than in the CTx group (71.7%) or noTx group (65.5%) (p = 0.001). Significant survival benefits of CRT over CTx (HR 0.602, p = 0.020 for overall survival (OS); HR 0.599, p = 0.016 for time to any recurrence (TTR)) were demonstrated in multivariate analysis. CRT group had more 5-year survivors than other groups. In the subgroup analysis, such benefits of adjuvant CRT over CTx was observed only in patients with head tumor & vascular RM > 0.5 mm, but not in patients with body/tail tumor or vascular RM ≤ 0.5 mm. In the CRT group, radiation dose≥54 Gy was significantly associated with better TTR and OS. Conclusions: Adjuvant CRT could improve TTR and OS compared to adjuvant CTx alone in patients with close RM under 2 mm. Radiation dose escalation may be beneficial when feasible. Modern CRT regimen–based randomized evidence is needed for these high-risk patients. © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
- DOI
- 10.1016/j.ejso.2020.07.029
- Appears in Collections:
- 의과대학 > 의학과 > Journal papers
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