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Chemotherapy improves survival after resection of pancreatic cancer

Last Updated: 2004-03-17 17:00:25 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Adjuvant chemotherapy appears to significantly increase survival in patients who have undergone surgical resection of pancreatic cancer, study results suggest. Chemoradiotherapy, on the other hand, appears to be detrimental.

"Standard care for patients with resectable pancreatic cancer should consist of curative surgery followed by adjuvant systemic chemotherapy," the European Study Group for Pancreatic Cancer concludes in the New England Journal of Medicine for March 18.

Led by Dr. John Neoptolemos at the University of Liverpool in the UK, the Study Group followed 289 patients who had undergone a complete macroscopic resection. Sixty-nine were assigned to observation only, 73 to chemotherapy alone, 73 to chemoradiotherapy alone, and 72 to chemoradiotherapy followed by chemotherapy.

Chemoradiotherapy comprised 20-Gy of radiation given over 2 weeks plus fluorouracil. Chemotherapy consisted of six cycles of leucovorin plus fluorouracil for 5 days every 28 days. The combination group received chemoradiotherapy followed by chemotherapy.

After a median follow-up of 47 months, 5-year survival estimates were 11% (observation), 7% (chemoradiation), 29% (chemotherapy) and 13% (chemoradiation followed by chemotherapy), but the authors note that their analysis lacked statistical power to compare groups directly.

Five-year survival rates were 21% among those given chemotherapy group versus 8% in for those not given chemotherapy (p = 0.009), with differences between groups detected at 8 months after resection. For those given chemoradiotherapy or no chemoradiotherapy, 5-year survival rates were 10% and 20% (p = 0.05).

Dr. Neoptolemos' group attributes the adverse effect of chemoradiotherapy to a delay in administration of chemotherapy, which "reduced the potential benefit of chemotherapy that is derived from delivering it as soon as possible after resection."

In a related editorial, Dr. Michael A. Choti, from Johns Hopkins Hospital in Baltimore, rejects treatment delay as the cause of reduced survival associated with chemoradiotherapy. He believes that consecutive administration of the two treatment regimens probably influenced compliance with chemotherapy and thus introduced bias.

Also, based on the comparison of the four treatment groups showing that chemoradiotherapy alone was associated with shorter survival than observation alone, Dr. Choti maintains that "the deleterious effect of chemoradiotherapy was indeed due to treatment-related toxic effects."

N Engl J Med 2004;350:1200-1210,1249-1251.

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