The Role of Radiotherapy in Resected R0/R+ Pancreatic Cancer

摘要

Purpose/Objective: The purpose of this study was to evaluate the role of external radiation therapy following resection of pancreatic cancer. Patients and Methods: Patients who underwent either Whipple procedure or distal pancreatectomy and treated with either chemo-radiotherapy (chemo-rad) or chemotherapy alone (R0 chemo) were enrolled in this study. The chemotherapy (chemo) was based on cisplatin and either gemcitabine or 5?FU/leukovorin. The total radiation dose was 50.4?Gy given in 1.8?Gy 5 times a week. Overall survival, based on resection margin, nodal status, and treatment type, was estimated in all patients. Results: Of the 734 referred patients, 134 underwent either Whipple procedure or distal pancreatectomy during the years 2000 to 2018. In total, 93 had complete tumor resection (R0 group), and 41 had involved resection margins (R+ group). An overall 49 of the 93 were treated with R0 chemo, and 44 were treated with chemo-rad (R0 chemo-rad). The median overall survival for the R0 group was 28 months; for R0 chemo, it was 29 months, and, for R0 chemo-rad, it was 27 months ( P -value, NS). For the 41 R+ group, it was 17 months and was significantly lower than that of R0 ( P <0.001). The survival of R+ chemo-rad (26 patients) was 23 months, and, for R+ chemo (15 patients), it was 12 months ( P =0.01). In total, 72 with positive nodes (N+) had shorter overall survival than those with N negative (22 and 27?mo, P =0.015). The survival of patients with N+/R0 chemo-rad and chemo was similar—31 and 27 months ( P -value, NS), and, in the N+/R+ group, the survival was 22 and 16 months in the chemo-rad and chemo only groups, respectively ( P =0.006). Conclusions: external radiation therapy increased significantly the overall survival of R+ resected pancreatic cancer but not N+ patients. Additional studies to delineate the role of chemo-rad in this setting are warranted.