Prognostic Value of Splenic Artery Invasion in Patients Undergoing Adjuvant Chemoradiotherapy after Distal Pancreatectomy for Pancreatic Adenocarcinoma
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Purpose The purpose of this study was to evaluate the outcome of adjuvant chemoradiotherapy(CRT) after distal pancreatectomy (DP) in patients with pancreatic adenocarcinoma, and toidentify the prognostic factors for these patients. Materials and MethodsWe performed a retrospective review of 62 consecutive patients who underwent curativeDP followed by adjuvant CRT between 2000 and 2011. There were 31 men and 31 women,and the median age was 64 years (range, 38 to 80 years). Adjuvant radiotherapy wasdelivered to the tumor bed and regional lymph nodes with a median dose of 50.4 Gy (range,40 to 55.8 Gy). All patients received concomitant chemotherapy, and 53 patients (85.5%)also received maintenance chemotherapy. The median follow-up period was 24 months. ResultsForty patients (64.5%) experienced relapse. Isolated locoregional recurrence developed in5 patients (8.1%) and distant metastasis in 35 patients (56.5%), of whom 13 had bothlocoregional recurrence and distant metastasis. The median overall survival (OS) anddisease-free survival (DFS) were 37.5 months and 15.4 months, respectively. On multivariateanalysis, splenic artery (SA) invasion (p=0.0186) and resection margin (RM) involvement(p=0.0004) were identified as significant adverse prognosticators for DFS. Also, male gender(p=0.0325) and RM involvement (p=0.0007) were associated with a significantly poor OS. Grade 3 or higher hematologic and gastrointestinal toxicities occurred in 22.6% and 4.8%of patients, respectively. ConclusionAdjuvant CRT may improve survival after DP for pancreatic body or tail adenocarcinoma. Our results indicated that SA invasion was a significant factor predicting inferior DFS, aswas RM involvement. When SA invasion is identified preoperatively, neoadjuvant treatmentmay be considered.
Abstract
Purpose The purpose of this study was to evaluate the outcome of adjuvant chemoradiotherapy(CRT) after distal pancreatectomy (DP) in patients with pancreatic adenocarcinoma, and toidentify the prognostic factors for these patients. Materials and MethodsWe performed a retrospective review of 62 consecutive patients who underwent curativeDP followed by adjuvant CRT between 2000 and 2011. There were 31 men and 31 women,and the median age was 64 years (range, 38 to 80 years). Adjuvant radiotherapy wasdelivered to the tumor bed and regional lymph nodes with a median dose of 50.4 Gy (range,40 to 55.8 Gy). All patients received concomitant chemotherapy, and 53 patients (85.5%)also received maintenance chemotherapy. The median follow-up period was 24 months. ResultsForty patients (64.5%) experienced relapse. Isolated locoregional recurrence developed in5 patients (8.1%) and distant metastasis in 35 patients (56.5%), of whom 13 had bothlocoregional recurrence and distant metastasis. The median overall survival (OS) anddisease-free survival (DFS) were 37.5 months and 15.4 months, respectively. On multivariateanalysis, splenic artery (SA) invasion (p=0.0186) and resection margin (RM) involvement(p=0.0004) were identified as significant adverse prognosticators for DFS. Also, male gender(p=0.0325) and RM involvement (p=0.0007) were associated with a significantly poor OS. Grade 3 or higher hematologic and gastrointestinal toxicities occurred in 22.6% and 4.8%of patients, respectively. ConclusionAdjuvant CRT may improve survival after DP for pancreatic body or tail adenocarcinoma. Our results indicated that SA invasion was a significant factor predicting inferior DFS, aswas RM involvement. When SA invasion is identified preoperatively, neoadjuvant treatmentmay be considered.
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