Adjuvant Chemoradiation for Adenocarcinoma of the Pancreas: The Johns Hopkins Experience
At the time of diagnosis, 15% to 20% of patients will have resectable pancreatic cancers. The 5-year survival for patients after surgical resection is between 20% and 25%. The use of chemotherapy and radiation therapy following surgery is controversial, with 3 clinical trials showing conflicting results regarding the benefits of chemoradiotherapy after surgery. American physicians tend to give chemo-radiotherapy in this disease, while their European counterparts often omit such therapy. This study was done to examine the effect of chemoradiation therapy after Whipple resection at a single, high-volume medical center.
The 155 patients included in the analysis received 5-FU and radiation therapy after surgical resection. There is a median follow up of 5.8 years. Patients who did not receive adjuvant therapy had worse median survival than the patients who received adjuvant therapy (16 months vs. 21 months with adjuvant therapy), worse 2-year overall survival (36% vs. 45% with adjuvant therapy), and worse 5-year overall survival (16% vs. 25% with adjuvant therapy).
These results compare favorably with results seen in previous randomized trials, despite the fact that the patients treated at Johns Hopkins had more advanced disease and higher positive margin rates. 5-FU-based chemoradiation after surgery is associated with improved survival compared to observation alone. Survival data from this series are consistent with previously reported studies of patients treated with adjuvant chemoradiation, and lend support to its continued use after definitive surgery.