Amini Arya, Jones Bernard L, Stumpf Priscilla, Leong Stephen, Lieu Christopher H, Weekes Colin, Davis S Lindsey, Messersmith Wells A, Purcell William T, Ghosh Debashis, Schefter Tracey, Goodman Karyn A
From the *Department of Radiation Oncology, †Division of Medical Oncology, Department of Medicine, and ‡Department of Biostatistics, University of Colorado School of Public Health, Aurora, CO.
Pancreas. 2017 Aug;46(7):904-912. doi: 10.1097/MPA.0000000000000876.
The role of radiotherapy (RT) in locally advanced pancreatic cancer (LAPC) is uncertain. This study examines patterns of care and survival outcomes of LAPC undergoing chemotherapy alone versus chemotherapy plus RT (C + RT).
The National Cancer Database was queried for nonmetastatic LAPC patients who received chemotherapy alone or C + RT.
Of the 13,695 patients included, 5306 underwent chemotherapy alone and 4971, C + RT. Use of C + RT declined from 2003 to 2011 (73%-53%), whereas chemotherapy alone increased. Of those receiving RT, rates of intensity-modulated radiotherapy (IMRT) increased (27%-72%), whereas 3-dimensional (3D) RT decreased (73%-28%). Unadjusted 1-year overall survival (OS) was longer for versus chemotherapy (45.6% vs 38.7%), as was 2-year OS (12.9% vs 11.9%) (hazard ratio, 0.88; 0.85-0.91; P < 0.001). Under multivariate analysis, C + RT was associated with improved OS (hazard ratio, 0.84; 0.81-0.87; P < 0.001). On subgroup analysis comparing C + IMRT, C + 3D RT, and chemotherapy alone, 1-year OS was 49.1%, 45.1%, and 38.7%, and 2-year OS was 13.1%, 11.6%, and 11.9% accordingly.
Utilization of RT in LAPC is decreasing, whereas chemotherapy alone is increasing. Of patients undergoing RT, rates of IMRT are increasing. Whereas C + IMRT appeared to be associated with improved OS compared with chemotherapy alone, 3D RT was not.
放射治疗（RT）在局部晚期胰腺癌（LAPC）中的作用尚不确定。本研究探讨了单纯接受化疗与化疗联合放疗（C+RT）的LAPC患者的治疗模式和生存结果。
在国家癌症数据库中查询单纯接受化疗或C+RT的非转移性LAPC患者。
纳入的13695例患者中，5306例单纯接受化疗，4971例接受C+RT。从2003年到2011年，C+RT的使用比例下降（从73%降至53%），而单纯化疗的比例上升。在接受放疗的患者中，调强放疗（IMRT）的比例增加（从27%增至72%），而三维（3D）放疗的比例下降（从73%降至28%）。未调整的1年总生存率（OS），C+RT组高于单纯化疗组（45.6%对38.7%），2年OS也是如此（12.9%对11.9%）（风险比，0.88；0.85 - 0.91；P<0.001）。多因素分析显示，C+RT与OS改善相关（风险比，0.84；0.81 - 0.87；P<0.001）。在比较C+IMRT、C+3D RT和单纯化疗的亚组分析中，1年OS分别为49.1%、45.1%和38.7%，2年OS分别为13.1%、11.6%和11.9%。
LAPC中放疗的使用在减少，而单纯化疗的使用在增加。在接受放疗的患者中，IMRT的比例在增加。与单纯化疗相比，C+IMRT似乎与OS改善相关，而3D RT则不然。
