Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation - Long-term results of EORTC trial 40891

被引:244
作者
Smeenk, Hans G. [1 ]
van Eijck, Casper H. J. [1 ]
Hop, Wim C. [1 ]
Erdmann, Joris [1 ]
Tran, Kheeye C. K. [1 ]
Debois, Muriel [1 ]
van Cutsem, Eric [1 ]
van Dekken, Herman [1 ]
Klinkenbijl, Jean H. [1 ]
Jeekel, Johannes [1 ]
机构
[1] Erasmus MC, NL-3015 GD Rotterdam, Netherlands
关键词
D O I
10.1097/SLA.0b013e318156eef3
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: The role of adjuvant chemoradiation in pancreatic cancer remains unclear. This report presents the long-term follow-up results of EORTC trial 40891, which assessed the role of chemoradiation in resectable pancreatic cancer. Methods: Two hundred eighteen patients were randomized after resection of the primary tumor. Eligible patients had T1-2 N0-N1a M0 pancreatic cancer or T1-3 N0-N1a M0 periampullary cancers, all histologic proven. Patients in the treatment group (n = 110) underwent postoperative chemoradiation (40 Gy plus 5-FU). Patients in the control group (n = 108) had no further adjuvant treatment. Findings: After a median follow-up of 11.7 years, 173 deaths (79%) have been reported. The overall survival did not differ between the 2 treatment groups (Chemoradiation treatment vs. Controls: death rate ratio 0.91, 95% CI: 0.68-1.23, P value 0.54). The 10-year overall survival was 18% in the whole population of patients (8% in the pancreatic head cancer group and 29% in the periampullary cancer group). Interpretation: These results confirm the previous short-term analysis, indicating no benefit of adjuvant chemoradiation over observation in patients with resected pancreatic cancer or periampullary cancer. Patients with pancreatic cancer may survive more than 10 years. Only I of 31 cases recurred after year 7.
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页码:734 / 740
页数:7
相关论文
共 52 条
[1]   ADJUVANT COMBINATION CHEMOTHERAPY (AMF) FOLLOWING RADICAL RESECTION OF CARCINOMA OF THE PANCREAS AND PAPILLA OF VATER - RESULTS OF A CONTROLLED, PROSPECTIVE, RANDOMIZED MULTICENTER STUDY [J].
BAKKEVOLD, KE ;
ARNESJO, B ;
DAHL, O ;
KAMBESTAD, B .
EUROPEAN JOURNAL OF CANCER, 1993, 29A (05) :698-703
[2]   RESULTS OF RESECTION FOR CANCER OF THE EXOCRINE PANCREAS - A STUDY FROM THE FRENCH-ASSOCIATION-OF-SURGERY [J].
BAUMEL, H ;
HUGUIER, M ;
MANDERSCHEID, JC ;
FABRE, JM ;
HOURY, S ;
FAGOT, H .
BRITISH JOURNAL OF SURGERY, 1994, 81 (01) :102-107
[3]   Relationship between hospital volume and late survival after pancreaticoduodenectomy [J].
Birkmeyer, JD ;
Warshaw, AL ;
Finlayson, SRG ;
Grove, MR ;
Tosteson, ANA .
SURGERY, 1999, 126 (02) :178-183
[4]   TREATMENT AND SURVIVAL IN 13560 PATIENTS WITH PANCREATIC-CANCER, AND INCIDENCE OF THE DISEASE, IN THE WEST MIDLANDS - AN EPIDEMIOLOGIC-STUDY [J].
BRAMHALL, SR ;
ALLUM, WH ;
JONES, AG ;
ALLWOOD, A ;
CUMMINS, C ;
NEOPTOLEMOS, JP .
BRITISH JOURNAL OF SURGERY, 1995, 82 (01) :111-115
[5]  
*CANC RES CAMP, 2005, FACTSH 9 3 SURV ENGL
[6]  
DOUGLASS HO, 1987, CANCER, V59, P2006
[7]  
EVANS DB, 1992, ARCH SURG-CHICAGO, V127, P1335
[8]   PATTERNS OF FAILURE IN GROSSLY RESECTED PANCREATIC DUCTAL ADENOCARCINOMA TREATED WITH ADJUVANT IRRADIATION +/- 5-FLUOROURACIL [J].
FOO, ML ;
GUNDERSON, LL ;
NAGORNEY, DM ;
MCLLRATH, DC ;
VANHEERDEN, JA ;
ROBINOW, JS ;
KVOLS, LK ;
GARTON, GR ;
MARTENSON, JA ;
CHA, SS .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1993, 26 (03) :483-489
[9]  
*GITSG, 1985, CANCER, V56, P2563
[10]  
*GITSG, 1979, ANN SURG, V189, P205