Gastrointestinal Cancer

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SU_18_2177 - A Retrospective Review of Pancreatic Adenocarcinoma Outcomes with Varying Chemo-Radiation Therapy Regimens

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

A Retrospective Review of Pancreatic Adenocarcinoma Outcomes with Varying Chemo-Radiation Therapy Regimens
E. M. Janowski, M. S. Peach, and W. T. Watkins; Department of Radiation Oncology, University of Virginia, Charlottesville, VA

Purpose/Objective(s): To report on our single institution survival and toxicity outcomes for pancreatic cancer patients treated with varying radiation dose fractionation and chemotherapy dose schedules.

Materials/Methods: A total of 99 pancreatic cancer patients treated between 2003-2015 were evaluated for overall survival (OS) and treatment related complications. Variables in estimating Cox proportional hazards and OS included age, concurrent chemotherapy, PTV dose, group stage, pre-treatment chemotherapy, post-treatment chemotherapy, surgery, race, sex, and RT-technique. Prescribed radiation doses ranged from 25-60 Gy in 1.8-5.0 Gy/day. The population included 47 neoadjuvant pancreatic adenocarcinoma patients and 32 definitive patients who received concurrent capecitabine and varying post-treatment chemotherapy regimens, and 20 adjuvant patients with varying treatment parameters. Severe acute toxicities requiring treatment discontinuation were also compared to clinical variables.

Results: Median OS was 7.8, 12.2, and 20 months in the definitive, neoadjuvant, and adjuvant treatment groups respectively, p<0.001. OS was statistically improved in patients with lower overall group stage, with a median OS of 22, 14.2, 9.5, and 6 months respectively for stage 1-2a, 2b, 3 and 4 patients. OS was also improved in patients who underwent a successful surgical resection, with a median OS of 20.5, 9.0, and 14 months for patients undergoing surgical resection, no surgery or an aborted surgical procedure, respectively (p<0.001). In the 32 definitive patients, 3-year OS was 8%, with post-treatment chemotherapy being significant for improved OS (HR=0.43, p=0.01); 6 month OS was 93% vs 35% between patients who did versus did not receive post-treatment chemotherapy. In the neoadjuvant patients, 3-year OS was 14% with the addition of post-CRT chemotherapy (HR=0.81, p=0.04) improving OS. In the adjuvant patients, the 3 year OS was 30%; 17 did not receive post-operative chemotherapy while 23 received gemcitabine-based post-treatment chemotherapy with no significant difference in OS (p=0.3). On multivariate analysis group stage (p=0.005, HR= 1.02) and receipt of chemotherapy either pre (p=0.009, HR=0.116) or post-operatively (p=0.017, HR=0.393) maintained significance. For toxicity, 20 complications were identified that required aborting treatment and hospitalization: 6 sepsis / infection, 10 intractable nausea/vomiting/diarrhea, 2 grade-3 bowel obstruction, 1 bowel perforation resulting in death, and 1 severe weight loss. No variables were significant predictors of toxicity.

Conclusion: We show large survival variations as a function of treatment intent and post-CRT chemotherapy regimens in pancreatic adenocarcinoma patients.

Author Disclosure: E. Janowski: None. M.S. Peach: None. W.T. Watkins: None.

Einsley-Marie Janowski, MD, PhD

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