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- W2972565362 abstract "Recent studies in operable pancreatic cancer have suggested a survival benefit of neoadjuvant therapy compared to upfront surgery, but the optimal preoperative approach is unclear. We compared outcomes of patients treated with neoadjuvant chemotherapy alone, chemotherapy with conventionally-fractionated radiation, or chemotherapy with stereotactic body radiotherapy (SBRT). The National Cancer Database was used to identify patients with non-metastatic pancreatic adenocarcinoma treated with preoperative chemotherapy (with or without radiation) and definitive surgery between 2004 and 2014. Fractionated radiation was defined as 40-60 Gy in 20-35 fractions, and SBRT was defined as 20-25 Gy in 1 fraction or 30-50 Gy using at least 5 Gy per fraction. The primary outcome was overall survival measured from surgery. Propensity score matching and multivariable regression were used to adjust for differences in baseline characteristics. In total, 2,933 patients were identified (42.7% chemotherapy alone, 51.8% chemotherapy with fractionated radiation, 5.5% chemotherapy with SBRT). Median follow-up was 2.4 years in living patients. Median overall survival after surgery was 21.5 months in the fractionated radiation cohort, 24 months in the chemotherapy only cohort, and 31 months in the SBRT cohort (log-rank p < 0.001). After propensity score matching, there was no significant survival difference between chemotherapy alone and chemotherapy with fractionated radiation (p = 0.30), whereas chemotherapy with SBRT had increased survival compared to chemotherapy alone (adjusted hazard ratio 0.69, 95% confidence interval: 0.51-0.94, p = 0.018). Receiving either fractionated radiation or SBRT increased the overall pathological response rate compared to chemotherapy alone (adjusted odds ratio 1.50, p < 0.001 and 1.61, p = 0.036 respectively). Rates of positive surgical margin and unplanned postoperative readmission did not differ among the cohorts. Neoadjuvant chemotherapy with SBRT is associated with the longest overall survival in patients with resected pancreas cancer. Prospective research to study this combination is warranted." @default.
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- W2972565362 date "2019-09-01" @default.
- W2972565362 modified "2023-09-26" @default.
- W2972565362 title "Defining the Optimal Neoadjuvant Treatment Strategy in Patients with Resectable Pancreas Cancer" @default.
- W2972565362 doi "https://doi.org/10.1016/j.ijrobp.2019.06.1939" @default.
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