Department of Radiation Oncology, Stanford University, United States; Affiliated Physician, Palo Alto Veterans Affairs Hospital, United States.
Department of Medicine, Division of Oncology, Stanford University, United States.
Radiother Oncol. 2020 Feb;143:101-107. doi: 10.1016/j.radonc.2020.01.007. Epub 2020 Feb 7.
The optimal neoadjuvant approach in patients with resectable pancreas cancer is unclear. We investigated outcomes after preoperative chemotherapy alone, chemotherapy with conventionally-fractionated radiation (CFRT), or chemotherapy with stereotactic body radiotherapy (SBRT).
The NCDB was queried for patients with resectable pancreatic adenocarcinoma (pretreatment stage T1-3, N0-1, M0) who received preoperative, multiagent chemotherapy and definitive surgery from 2010 to 2015. CFRT was 40-60 Gy in 20-35 fractions. SBRT was 20-25 Gy in 1 fraction or 30-50 Gy using at least 5 Gy per fraction. Multivariable regression and propensity score matching were used to adjust for potential confounders, including age, comorbidity score, and pretreatment extent of disease. The primary outcome was overall survival measured from surgery.
In total, 1355 patients received preoperative chemotherapy alone, 552 patients received preoperative chemotherapy with CFRT, and 175 patients received preoperative chemotherapy with SBRT. Receipt of SBRT was associated with significantly improved overall survival compared to chemotherapy alone (median 30 vs 21 months, p = 0.02; adjusted hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.47-0.90, p = 0.01). Similarly, SBRT was associated with significantly improved overall survival compared to CFRT (median 29 vs 16 months, p = 0.002; adjusted HR 0.53, 95% CI 0.37-0.76, p = 0.001). Additionally, SBRT was associated with significantly increased rates of pathological complete response and margin-negative resection. Rates of postoperative readmissions and mortality were comparable.
Neoadjuvant chemotherapy with SBRT is associated with favorable survival and pathological outcomes, warranting consideration for prospective validation.
在可切除胰腺癌患者中，最佳的新辅助治疗方法尚不清楚。我们研究了单独接受术前化疗、常规分割放疗（CFRT）联合化疗或立体定向体部放疗（SBRT）联合化疗的患者的结局。
从 2010 年至 2015 年，美国国家癌症数据库（NCDB）检索了接受新辅助、多药化疗和确定性手术治疗的可切除胰腺腺癌（术前分期 T1-3、N0-1、M0）患者。CFRT 剂量为 40-60Gy，分割 20-35 次。SBRT 剂量为 20-25Gy/1 次或 30-50Gy/次，至少 5Gy/次。多变量回归和倾向评分匹配用于调整潜在混杂因素，包括年龄、合并症评分和术前疾病程度。主要结局是从手术开始的总生存。
共有 1355 例患者接受了单纯术前化疗，552 例患者接受了术前 CFRT 联合化疗，175 例患者接受了术前 SBRT 联合化疗。与单纯化疗相比，SBRT 治疗显著提高了总生存率（中位 30 个月 vs 21 个月，p=0.02；调整后的风险比[HR]0.65，95%置信区间[CI]0.47-0.90，p=0.01）。同样，与 CFRT 相比，SBRT 治疗显著提高了总生存率（中位 29 个月 vs 16 个月，p=0.002；调整后的 HR 0.53，95%CI 0.37-0.76，p=0.001）。此外，SBRT 与较高的病理完全缓解率和切缘阴性切除率相关。术后再入院率和死亡率相似。
SBRT 联合新辅助化疗可带来有利的生存和病理结局，值得进一步前瞻性验证。
