Suss NR, et al. - This paper incorporated an investigation of the benefits of external beam radiation addition to adjuvant chemotherapy after R1 resections in patients with pancreatic ductal adenocarcinoma. A survival benefit albeit limited (about 2 months), was obtained due to the addition of radiation to adjuvant chemotherapy after a margin positive resection in patients with node-positive pancreatic head cancer.

Methods

• A scrutiny was carried out of the the utility of adjuvant radiation in patients with pathologic stage I-II pancreatic ductal adenocarcinoma, who underwent upfront pancreatoduodenectomy with a positive margin (margin positive resection).
• Researchers examined the National Cancer Data Base between 2004 and 2013.

Results

• A total of 1,392 patients met the inclusion criteria.
• Among the subjects, 263 (18.9%) were lymph node-negative (pathologic stages IA, IB, IIA) and 1,129 (81.1%) were node-positive (pathologic stage IIB).
• Herein, 938 (67.4%) patients received adjuvant radiation and chemotherapy, while 454 (32.6%) received adjuvant chemotherapy alone.
• The benefit of radiation to be statistically prominent only in node positive patients (hazard ratio 0.81, 95% confidence interval, 0.71-0.93) was illustrated via Cox modeling stratified by nodal status.
• An adjusted median survival of 17.5 months vs 15.2 months was reported among node-positive patients receiving adjuvant radiation and chemotherapy, than those receiving adjuvant chemotherapy alone (P=.003).
• No variation was discovered in the overall survival with radiation among patients who had negative nodes (22.5 vs 23.6 months, P=.511).