Background

Most patients with pancreatic adenocarcinoma (PDAC) do not undergo surgical resection. The role of radiotherapy (RT) in non-operatively managed localized pancreatic adenocarcinoma is unclear.

Methods

The National Cancer Database (2010–2016) was queried for patients with clinical stage II-III PDAC treated with multiagent systemic chemotherapy (CT) +/− RT but not surgery. Factors associated with the receipt of RT and overall survival were compared after adjusting for patient demographics and clinical characteristics.

Results

A total of 14,921 patients were included, of whom 9279 received CT and 5382 received CT + RT. Patients treated with CT + RT were more likely to be younger (65vs66yrs), treated at non-academic facilities (48.8%vs46.7%), have private insurance (40.3%vs36.5%), and have clinical T4 tumors (53.6%vs48.7%). Most patients who were treated with RT received external beam radiotherapy (89.3%), and the median dose was 5,000 cGy. Median time to start of RT was 129 days. CT + RT was associated with longer overall survival (15.9vs11.8mos,p < 0.001), and remained associated with survival on multivariable analysis (HR 0.74, 95%CI 0.70–0.78). On a 4-month conditional survival analysis, combined CT + RT remained associated with improved survival compared to CT alone (16.0vs13.1mos,p < 0.001).

Conclusions

In patients with non-operatively managed localized pancreatic adenocarcinoma, combined radiotherapy and multiagent systemic chemotherapy is associated with improved overall survival compared to chemotherapy alone.

中文翻译：

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联合多药化疗和放疗与非手术治疗的 II-III 期胰腺癌患者的总生存期延长相关

 背景

大多数胰腺腺癌（PDAC）患者不接受手术切除。放射治疗（RT）在非手术治疗的局限性胰腺癌中的作用尚不清楚。

 方法

查询了国家癌症数据库（2010-2016）中接受多药全身化疗（CT）+/- RT 但未接受手术治疗的临床 II-III 期 PDAC 患者。在调整患者人口统计数据和临床特征后，对与接受放疗和总生存率相关的因素进行了比较。

 结果

总共纳入 14,921 例患者，其中 9279 例接受 CT，5382 例接受 CT + RT。接受 CT + RT 治疗的患者更有可能更年轻（65 岁 vs 66 岁）、在非学术机构接受治疗（48.8% vs 46.7%）、拥有私人保险（40.3% vs 36.5%）以及患有临床 T4 肿瘤（53.6 %vs48.7%）。大多数接受放疗的患者接受了外照射放疗（89.3%），中位剂量为5,000 cGy。开始 RT 的中位时间为 129 天。 CT + RT 与较长的总生存期相关（15.9vs11.8mos，p < 0.001），并且在多变量分析中仍与生存相关（HR 0.74，95%CI 0.70-0.78）。在 4 个月的条件生存分析中，与单独使用 CT 相比，联合 CT + RT 仍然与改善生存相关（16.0vs13.1mos，p < 0.001）。

 结论

在非手术治疗的局限性胰腺癌患者中，与单独化疗相比，联合放疗和多药全身化疗可改善总生存期。