2008 Annual Meeting Abstracts
A Neoadjuvant Strategy for Pancreatic Adenocarcinoma Helps Patients Receive All Components of Care: Lessons from a Single-institution Database
May Piperdi, M.D., Theodore P. McDade, MD, Joon K. Shim, MD, Mary E. Sullivan, NP, Giles L. Whalen, MD, Jennifer F. Tseng, MD.
University of Massachusetts, Worcester, MA, USA.
Objective: To evaluate factors predictive of pancreatic adenocarcinoma patients receiving both surgical resection and adjuvant therapy.
Design: Single-institution prospective database; retrospective analysis.
Setting: University teaching hospital.
Patients: 102 consecutive pancreatic adenocarcinoma patients referred for surgical evaluation, 2002-2007.
Main Outcome Measures:
1. Receipt of surgical resection and/or chemoradiation.
Results: Mean age was 65 years (range 41-85); 47.1% were female. Of 102 patients, 51 were deemed to have localized disease (50.0%), 26 borderline (25.5%), 11 locally unresectable (10.8%), and 14 metastatic (13.7%). 58 patients were taken to surgery with curative intent (39 localized, 19 borderline), of whom 36 and 16 were successfully resected, respectively. Of resected patients with localized disease, 17 of 36 (47.2%) completed scheduled adjuvant therapy; none received neoadjuvant therapy. In contrast, 13 out of 16 (81.3%) of the resected borderline patients completed chemoradiation as planned. Nearly half of these (6 of 13) received up-front "neoadjuvant" rather than traditional post-operative therapy. Median survival for all resected patients was 441 days versus 224 for unresected patients (p<0.0001). Median survival for patients undergoing resection alone was 420 days versus 484 for patients additionally receiving at least some chemoradiation (p=0.0269). A trend toward improved survival was observed for complete vs. incomplete chemoradiation (p=0.084).
Conclusions: Surgical resection remains the most powerful predictor of survival in patients diagnosed with pancreatic cancer. The addition of adjuvant therapy adds significantly to the survival benefit. A subset analysis of patients with resected borderline cancers demonstrated improved adjuvant chemoradiation completion rates compared to patients with localized disease, largely from the up-front approach used in the borderline group. Broader use of neoadjuvant therapy for resectable pancreatic cancer may be warranted.