Adjuvant chemoradiation in pancreatic cancer: Impact of radiotherapy dose on survival

AG Morganti, F Cellini, M Buwenge, A Arcelli, S Alfieri, FA Calvo, R Casadei, S Cilla, F Deodato, G Di Gioia, M Di Marco, L Fuccio, F Bertini, A Guido, JM Herman, G Macchia, BW Maidment, RC Miller, F Minni, P PassoniC Valentini, A Re, WF Regine, M Reni, M Falconi, V Valentini, GC Mattiucci

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Background: To evaluate the impact of radiation dose on overall survival (OS) in patients treated with adjuvant chemoradiation (CRT) for pancreatic ductal adenocarcinoma (PDAC). Methods: A multicenter retrospective analysis on 514 patients with PDAC (T1-4; N0-1; M0) treated with surgical resection with macroscopically negative margins (R0-1) followed by adjuvant CRT was performed. Patients were stratified into 4 groups based on radiotherapy doses (group 1: <45 Gy, group 2: ≥ 45 and <50 Gy, group 3: ≥ 50 and <55 Gy, group 4: ≥ 55 Gy). Adjuvant chemotherapy was prescribed to 141 patients. Survival functions were plotted using the Kaplan-Meier method and compared through the log-rank test. Results: Median follow-up was 35 months (range: 3-120 months). At univariate analysis, a worse OS was recorded in patients with higher preoperative Ca 19.9 levels (≥ 90 U/ml; p <0.001), higher tumor grade (G3-4, p = 0.004), R1 resection (p = 0.004), higher pT stage (pT3-4, p = 0.002) and positive nodes (p <0.001). Furthermore, patients receiving increasing doses of CRT showed a significantly improved OS. In groups 1, 2, 3, and 4, median OS was 13.0 months, 21.0 months, 22.0 months, and 28.0 months, respectively (p = 0.004). The significant impact of higher dose was confirmed by multivariate analysis. Conclusions: Increasing doses of CRT seems to favorably impact on OS in adjuvant setting. The conflicting results of randomized trials on adjuvant CRT in PDAC could be due to <45 Gy dose generally used. © 2019 The Author(s).
Original languageEnglish
JournalBMC Cancer
Publication statusPublished - 2019


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