방사선의학 웹진

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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.

Overall survival by adjuvant treatment and radiation dose groups

Affiliations

Byoung Hyuck Kim  1 , Kyubo Kim  2 , Jin-Young Jang  3 , Wooil Kwon  3 , Hongbeom Kim  3 , Kyung-Hun Lee  4 , Do-Youn Oh  4 , Haeryoung Kim  5 , Kyung Bun Lee  5 , Eui Kyu Chie  6
1 Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea.
2 Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, South Korea. Electronic address: kyubokim.ro@gmail.com.
3 Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
4 Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
5 Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea.
6 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, South Korea. Electronic address: ekchie93@snu.ac.kr.