Adjuvant chemoradiotherapy for high-risk pancreatic cancer

Introduction : The role of adjuvant chemoradiotherapy for resected pancreatic cancer remains controversial. Several trials have failed to draw firm conclusions. The risk of local and metastatic relapse remains high after radical surgery. This is a single institutional review, evaluating the outcomes of patients with high-risk resected pancreatic cancer and treated with adjuvant chemoradiotherapy. Methods: A retrospective review was conducted on 18 consecutive patients with pancreatic cancer and treated with adjuvant chemoradiotherapy at the Department of Radiation Oncology, National Cancer Centre, Singapore, between January 2000 and December 2004. 56 percent were women. The mean age was 61.5 (range 50-73) years. Patients had either AJCC 2002 Stage I (17 percent), Stage II (11 percent), Stage III (22 percent) or Stage IVA (50 percent). The median radiation dose delivered was 5,400 (range 4,140-5,500) cGy using 180 cGy fractions. Concurrent chemotherapy was administered with 5-fluorouracil (56 percent), gemcitabine (28 percent) or capacetabine (17 percent). Results: The median follow-up of patients still alive at the time of analysis was 48 months. Metastatic disease had developed in 13 patients. Two patients had local recurrence within the radiation field. The median survival of the cohort is 21.6 (range 8.5-62.7) months. One-year survival is 89 percent, 2-year survival 39 percent and 3-year survival 28 percent. Conclusion: The data supports the use of adjuvant chemoradiotherapy for high-risk pancreatic cancer. Our results are comparable to published data from similar studies. Although radiotherapy is effective in reducing local failure, effective systemic treatment is also essential.