Chemoradiation in patients with locally advanced pancreatic adenocarcinoma

Abstract

Introduction: Trimodality treatment in patients with locally advanced pancreatic adenocarcinoma is still very controversial. The aim of this study was to evaluate the role of chemoradiation and neoadjuvant chemotherapy in locally advanced pancreatic adenocarcinoma. Methods: Medical files of 43 patients with confirmed locally advanced pancreatic adenocarcinoma who presented to our centre between 2000 and 2016 were retrospectively reviewed. Multimodality treatment consisting of surgery, chemo-radiotherapy or chemotherapy alone was planned according to tumour extend and performance status of the patient. Results: Demographic characteristics showed a higher incidence in men (62.8%) and median age at diagnosis was 59.3 (range 45-82). The tumour was localised in the cephalic region in 88.4% of cases. Therapeutic sequence was surgery followed by adjuvant chemotherapy in 30 patients (69.8%) and 27 patients (62.8%) received concurrent chemo-radiotherapy. Neoadjuvant chemotherapy was administered in 13 patients (30.2%). After a median follow up of 19.9 months, median overall survival (OS) for the population was 18.5 months, with one year survival rate of 85% and 2 year survival of 46%. Chemoradiation improved median survival versus chemotherapy alone (21 vs. 19 months p=0.056), even if the patient had lymph node involvement. Overall survival was better if after surgery adjuvant chemotherapy was administered (19 vs. 13 months, p=0.003). Adjuvant chemotherapy consisted of Gemcitabine regimen in 81.4% and 5-Fluorouracil plus leucovorin in 18.6%. In our series gemcitabine based chemotherapy was better than 5-Flurouracil (19 vs. 14 months). Neoadjuvant chemotherapy was not able to improve overall survival if the patients were not converted to surgery. Conclusion: Multimodality treatment in locally advanced pancreatic cancers (surgery, concurrent radio-chemotherapy and adjuvant chemotherapy) can improve outcome of patients with locally advanced pancreatic cancer.