Department of Radiation Oncology, Emory University, Atlanta, GA, USA.
Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Ann Surg Oncol. 2018 Apr;25(4):1026-1033. doi: 10.1245/s10434-017-6322-4. Epub 2018 Jan 11.
The LAP07 randomized trial calls into question the role of radiation therapy (RT) in the modern treatment of locally advanced pancreatic cancer (LAPC). However, advances in chemotherapy and RT limit application of the LAP07 results to current clinical practice. Here we utilize the National Cancer Database (NCDB) to evaluate the effects of RT in patients receiving chemotherapy for LAPC.
Using the NCDB, patients with American Joint Committee on Cancer (AJCC) clinical stage T2-4, N0-1, M0 adenocarcinoma of the pancreas from 2004 to 2014 were analyzed. Patients were stratified into chemotherapy only (CT) and chemoradiation (CRT) cohorts. Patients undergoing definitive RT, defined as at least 20 fractions or ≥ 5 Gy per fraction [i.e., stereotactic body radiation therapy (SBRT)] were included in the CRT cohort. Propensity-score matching (PSM) and landmark analysis were used to address selection bias and lead-time bias, respectively.
13,004 patients met inclusion criteria, of whom 7034 (54%) received CT and 5970 (46%) received CRT. After PSM, 5215 patients remained in each cohort. The CRT cohort demonstrated better overall survival (OS) compared with CT alone, with median and 1-year OS of 12 versus 10 months, and 50% and 41%, respectively (p < 0.001). On multivariable analysis, CRT was associated with superior OS with hazard ratio of 0.79 (95% confidence interval 0.76-0.83) compared with CT alone.
In our series, addition of definitive radiotherapy to CT was associated with better OS when compared with CT alone in LAPC. Definitive radiotherapy should remain a treatment option for LAPC, but optimal selection criteria remain unclear.
LAP07 随机试验对局部晚期胰腺癌（LAPC）的现代放射治疗（RT）作用提出了质疑。然而，化疗和 RT 的进步限制了 LAP07 结果在当前临床实践中的应用。在这里，我们利用国家癌症数据库（NCDB）来评估接受化疗治疗的 LAPC 患者接受 RT 的效果。
使用 NCDB，分析了 2004 年至 2014 年美国癌症联合委员会（AJCC）临床分期为 T2-4、N0-1、M0 腺癌的胰腺患者。患者分为单纯化疗（CT）和放化疗（CRT）两组。接受明确 RT 的患者（定义为至少 20 个分次或每个分次≥5 Gy[即立体定向体部放射治疗（SBRT）]）被归入 CRT 组。采用倾向评分匹配（PSM）和 landmark 分析分别解决选择偏倚和领先时间偏倚。
共有 13004 例患者符合纳入标准，其中 7034 例（54%）接受 CT，5970 例（46%）接受 CRT。PSM 后，每组仍有 5215 例患者。与单独 CT 相比，CRT 组的总生存（OS）更好，中位和 1 年 OS 分别为 12 个月和 10 个月，50%和 41%（p<0.001）。多变量分析显示，与单独 CT 相比，CRT 与 OS 改善相关，风险比为 0.79（95%置信区间 0.76-0.83）。
在我们的系列研究中，与单独 CT 相比，LAPC 患者在接受 CT 加根治性放疗后 OS 更好。根治性放疗仍应作为 LAPC 的一种治疗选择，但最佳选择标准仍不明确。
