Source: DGNews  |  Posted 2 years ago

By Wayne Kuznar

PHOENIX, Ariz -- March 9, 2009 -- Adjuvant therapy prior to surgery doubles survival time in patients with pancreatic adenocarcinoma compared with surgery alone, researchers stated here at the Society of Surgical Oncology (SSO) 62nd Annual Cancer Symposium.

Patients with pancreatic cancer, therefore, should be offered multimodal therapy, stated Karyn B. Stitzenberg, MD, MPH, Fox Chase Cancer Center, Philadelphia, Pennsylvania, speaking at a poster session here on March 7.

Dr. Stitzenberg led a team of colleagues in performing a retrospective outcome review of 209 patients who underwent pancreatic resections for pancreatic adenocarcinoma between 1996 and 2006. Forty-four percent of patients (92/209) underwent chemotherapy and/or chemoradiotherapy prior to resection.

Survival was compared between patients who received neoadjuvant chemotherapy and/or chemoradiotherapy and those who received surgery first. The surgery-first group included patients who had received surgery alone and those who had received surgery followed by chemotherapy and/or chemoradiotherapy.

"A substantial proportion of the patients treated with surgery first never receive adjuvant therapy," noted Dr. Stitzenberg. Indeed, in the surgery-first group, only 79% received chemotherapy and/or chemoradiation afterward.

Vascular resection was required in 33% (30/92) of patients who received neoadjuvant therapy compared with only 10% (12/117) of patients who underwent surgery first (P < .001).

The length of stay in the hospital was longer in patients who received neoadjuvant therapy compared with those who received surgery first (18 days vs 14 days, respectively; P = .005).

The group of patients who received adjuvant therapy after surgery had a median survival of 20 months, compared with 9 months among the group that received surgery alone (P < .001).

Median survival in the patients who received neoadjuvant therapy was 21 months, compared with 18 months in those who underwent surgery first (P = .299).

"Despite having more advanced tumours at baseline, patients treated with neoadjuvant therapy had equivalent survival to those treated with surgery first," Dr. Stitzenberg concluded.

Neoadjuvant therapy should be considered as a means of assuring that patients receive multimodal therapy, she noted, given that 21% of patients who underwent surgery first never received chemotherapy or chemoradiation.

[Presentation title: Optimizing Multimodality Therapy for Pancreatic Adenocarcinoma. Abstract P157]