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Postoperative radiation, lymph node dissection shows promise in lymph-node positive patients with pancreatic cancer
Patients with lymph node-positive, surgically resected prostate cancer who received chemotherapy demonstrated a lower risk for mortality when treated with postoperative radiation therapy and lymph node dissection, according to study results.
Researchers used the 2004 to 2008 SEER database to identify 2,966 patients who underwent pancreatic resection. Of those patients, 1,842 also underwent adjuvant radiation therapy.
Median OS was 21 months among patients who underwent postoperative radiation therapy vs. 20 months among those who did not. Researchers reported higher rates of 1-year OS (77% vs. 70%) and 3-year OS (28% vs. 25%) among patients who underwent radiation therapy (P=.02).
A subset analysis showed the survival benefit associated with postoperative radiation therapy was limited to lymph node-positive (N1) patients. Among these patients, median OS was 19 months for those who underwent radiation vs. 18 months for those who did not. Researchers reported higher rates of 1-year OS (73% vs. 67%) and 3-year OS (25% vs. 20%) among patients with N1 disease (P˂.01).
Results of multivariate analysis showed increased lymph node count was associated with improved survival for all patients (P˂.001) and patients with N1 disease (P˂.001).
Multivariate analysis also showed several factors — older age, T3 and T4 tumor classification, N1 stage, and moderately and poorly differentiated grade — were associated with increased mortality. Female gender, postoperative radiation therapy and lymph node dissection were associated with decreased mortality.
T1 and T2 tumor classification and tumors less than high grade were associated with a survival benefit in patients with lymph node-negative disease.
Disclosure: See the study for a full list of the researchers’ relevant financial disclosures.
Perspective
Back to TopIt is useful to use large databases to try to inform us on patterns of practice and to help design hypothesis-driven studies for the future. Dr. Mellon’s team has proposed that adjuvant radiotherapy has a utility in the management of node-positive pancreas cancer, focusing on disease-free interval and milestones of survival at 1 year and 3 years. Although the data are certainly interesting, it behooves us to note that the median survival figures are barely different between test and control populations, and the OS at 1 year and 3 years remain disappointingly low. As I view this study, it simply serves to remind us that patients with pancreatic cancer should be recruited to innovative and well-designed early phase and then randomized trials that test novel approaches to treatment. I think we have proven that incremental science is not going to have a significant impact on pancreas cancer after decades of work that have left cure rates at a very low level. Incremental science did not impact melanoma. It was bold and thoughtful, hypothesis-driven preclinical research, focusing on identified targets, that led to the present quantum leaps.