Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas: Results of a large, prospectively collected database at the Johns Hopkins Hospital

Joseph M. Herman, Michael J. Swartz, Charles C. Hsu, Jordan Winter, Timothy M. Pawlik, Elizabeth Sugar, Ray Robinson, Daniel Laheru, Elizabeth Jaffee, Ralph H Hruban, Kurtis A. Campbell, Christopher Wolfgang, Fariba Asrari, Ross C Donehower, Manuel Hidalgo, Luis A. Diaz, Charles Yeo, John L Cameron, Richard D. Schulick, Ross Abrams

Research output: Contribution to journalArticle

Abstract

Purpose: To examine the efficacy of adjuvant chemoradiotherapy after pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PC) in patients undergoing resection at Johns Hopkins Hospital (JHH; Baltimore, MD). Patients and Methods: Between August 30, 1993, and February 28, 2005, a total of 908 patients underwent PD for PC at JHH. A prospective database was reviewed to determine which patients received fluorouracil (FU) -based CRT. Excluded patients had metastatic disease, died 60 or fewer days after PD, received preoperative therapy, an experimental vaccine, adjuvant chemotherapy or radiation alone. The final cohort includes 616 patients. Results: The median follow-up was 17.8 months (interquartile range, 9.7 to 33.5 months). Overall median survival was 17.9 months (95% CI, 16.3 to 19.5 months). Groups were similar with respect to tumor size, nodal status, and margin status, but the CRT group was younger (P <.001), and less likely to present with a severe comorbid disease (P = .001). Patients with carcinomas larger than 3 cm (P = .001), grade 3 and 4 (P <.001), margin-positive resection (P = .001), and complications after surgery (P = .017) had poor long-term survival. Patients receiving CRT experienced an improved median (21.2 v 14.4 months; P <.001), 2-year (43.9% v 31.9%), and 5-year (20.1% v 15.4%) survival compared with no CRT. After controlling for high-risk features, CRT was still associated with improved survival (relative risk = 0.74; 95% CI, 0.62 to 0.89). Conclusion: These data suggest that adjuvant concurrent FU-based CRT significantly improves survival after PD for PC when compared with patients not receiving CRT. These data support the use of combined adjuvant CRT for PC.

Original languageEnglish (US)
Pages (from-to)3503-3510
Number of pages8
JournalJournal of Clinical Oncology
Volume26
Issue number21
DOIs
StatePublished - 2008

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Pancreaticoduodenectomy
Adjuvant Chemotherapy
Fluorouracil
Pancreas
Adenocarcinoma
Databases
Radiation
Survival
Adjuvant Chemoradiotherapy
Active Immunotherapy
Baltimore
Investigational Therapies
Carcinoma

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

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Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas : Results of a large, prospectively collected database at the Johns Hopkins Hospital. / Herman, Joseph M.; Swartz, Michael J.; Hsu, Charles C.; Winter, Jordan; Pawlik, Timothy M.; Sugar, Elizabeth; Robinson, Ray; Laheru, Daniel; Jaffee, Elizabeth; Hruban, Ralph H; Campbell, Kurtis A.; Wolfgang, Christopher; Asrari, Fariba; Donehower, Ross C; Hidalgo, Manuel; Diaz, Luis A.; Yeo, Charles; Cameron, John L; Schulick, Richard D.; Abrams, Ross.

In: Journal of Clinical Oncology, Vol. 26, No. 21, 2008, p. 3503-3510.

Research output: Contribution to journalArticle

Herman, Joseph M. ; Swartz, Michael J. ; Hsu, Charles C. ; Winter, Jordan ; Pawlik, Timothy M. ; Sugar, Elizabeth ; Robinson, Ray ; Laheru, Daniel ; Jaffee, Elizabeth ; Hruban, Ralph H ; Campbell, Kurtis A. ; Wolfgang, Christopher ; Asrari, Fariba ; Donehower, Ross C ; Hidalgo, Manuel ; Diaz, Luis A. ; Yeo, Charles ; Cameron, John L ; Schulick, Richard D. ; Abrams, Ross. / Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas : Results of a large, prospectively collected database at the Johns Hopkins Hospital. In: Journal of Clinical Oncology. 2008 ; Vol. 26, No. 21. pp. 3503-3510.
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abstract = "Purpose: To examine the efficacy of adjuvant chemoradiotherapy after pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PC) in patients undergoing resection at Johns Hopkins Hospital (JHH; Baltimore, MD). Patients and Methods: Between August 30, 1993, and February 28, 2005, a total of 908 patients underwent PD for PC at JHH. A prospective database was reviewed to determine which patients received fluorouracil (FU) -based CRT. Excluded patients had metastatic disease, died 60 or fewer days after PD, received preoperative therapy, an experimental vaccine, adjuvant chemotherapy or radiation alone. The final cohort includes 616 patients. Results: The median follow-up was 17.8 months (interquartile range, 9.7 to 33.5 months). Overall median survival was 17.9 months (95{\%} CI, 16.3 to 19.5 months). Groups were similar with respect to tumor size, nodal status, and margin status, but the CRT group was younger (P <.001), and less likely to present with a severe comorbid disease (P = .001). Patients with carcinomas larger than 3 cm (P = .001), grade 3 and 4 (P <.001), margin-positive resection (P = .001), and complications after surgery (P = .017) had poor long-term survival. Patients receiving CRT experienced an improved median (21.2 v 14.4 months; P <.001), 2-year (43.9{\%} v 31.9{\%}), and 5-year (20.1{\%} v 15.4{\%}) survival compared with no CRT. After controlling for high-risk features, CRT was still associated with improved survival (relative risk = 0.74; 95{\%} CI, 0.62 to 0.89). Conclusion: These data suggest that adjuvant concurrent FU-based CRT significantly improves survival after PD for PC when compared with patients not receiving CRT. These data support the use of combined adjuvant CRT for PC.",
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T1 - Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas

T2 - Results of a large, prospectively collected database at the Johns Hopkins Hospital

AU - Herman, Joseph M.

AU - Swartz, Michael J.

AU - Hsu, Charles C.

AU - Winter, Jordan

AU - Pawlik, Timothy M.

AU - Sugar, Elizabeth

AU - Robinson, Ray

AU - Laheru, Daniel

AU - Jaffee, Elizabeth

AU - Hruban, Ralph H

AU - Campbell, Kurtis A.

AU - Wolfgang, Christopher

AU - Asrari, Fariba

AU - Donehower, Ross C

AU - Hidalgo, Manuel

AU - Diaz, Luis A.

AU - Yeo, Charles

AU - Cameron, John L

AU - Schulick, Richard D.

AU - Abrams, Ross

PY - 2008

Y1 - 2008

N2 - Purpose: To examine the efficacy of adjuvant chemoradiotherapy after pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PC) in patients undergoing resection at Johns Hopkins Hospital (JHH; Baltimore, MD). Patients and Methods: Between August 30, 1993, and February 28, 2005, a total of 908 patients underwent PD for PC at JHH. A prospective database was reviewed to determine which patients received fluorouracil (FU) -based CRT. Excluded patients had metastatic disease, died 60 or fewer days after PD, received preoperative therapy, an experimental vaccine, adjuvant chemotherapy or radiation alone. The final cohort includes 616 patients. Results: The median follow-up was 17.8 months (interquartile range, 9.7 to 33.5 months). Overall median survival was 17.9 months (95% CI, 16.3 to 19.5 months). Groups were similar with respect to tumor size, nodal status, and margin status, but the CRT group was younger (P <.001), and less likely to present with a severe comorbid disease (P = .001). Patients with carcinomas larger than 3 cm (P = .001), grade 3 and 4 (P <.001), margin-positive resection (P = .001), and complications after surgery (P = .017) had poor long-term survival. Patients receiving CRT experienced an improved median (21.2 v 14.4 months; P <.001), 2-year (43.9% v 31.9%), and 5-year (20.1% v 15.4%) survival compared with no CRT. After controlling for high-risk features, CRT was still associated with improved survival (relative risk = 0.74; 95% CI, 0.62 to 0.89). Conclusion: These data suggest that adjuvant concurrent FU-based CRT significantly improves survival after PD for PC when compared with patients not receiving CRT. These data support the use of combined adjuvant CRT for PC.

AB - Purpose: To examine the efficacy of adjuvant chemoradiotherapy after pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PC) in patients undergoing resection at Johns Hopkins Hospital (JHH; Baltimore, MD). Patients and Methods: Between August 30, 1993, and February 28, 2005, a total of 908 patients underwent PD for PC at JHH. A prospective database was reviewed to determine which patients received fluorouracil (FU) -based CRT. Excluded patients had metastatic disease, died 60 or fewer days after PD, received preoperative therapy, an experimental vaccine, adjuvant chemotherapy or radiation alone. The final cohort includes 616 patients. Results: The median follow-up was 17.8 months (interquartile range, 9.7 to 33.5 months). Overall median survival was 17.9 months (95% CI, 16.3 to 19.5 months). Groups were similar with respect to tumor size, nodal status, and margin status, but the CRT group was younger (P <.001), and less likely to present with a severe comorbid disease (P = .001). Patients with carcinomas larger than 3 cm (P = .001), grade 3 and 4 (P <.001), margin-positive resection (P = .001), and complications after surgery (P = .017) had poor long-term survival. Patients receiving CRT experienced an improved median (21.2 v 14.4 months; P <.001), 2-year (43.9% v 31.9%), and 5-year (20.1% v 15.4%) survival compared with no CRT. After controlling for high-risk features, CRT was still associated with improved survival (relative risk = 0.74; 95% CI, 0.62 to 0.89). Conclusion: These data suggest that adjuvant concurrent FU-based CRT significantly improves survival after PD for PC when compared with patients not receiving CRT. These data support the use of combined adjuvant CRT for PC.

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