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Pancreatic Neoplasms: HELP
Articles by Robert C. Miller
Based on 10 articles published since 2010
(Why 10 articles?)
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Between 2010 and 2020, Robert Miller wrote the following 10 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Article Adjuvant chemoradiation in pancreatic cancer: impact of radiotherapy dose on survival. 2019

Morganti, Alessio G / Cellini, Francesco / Buwenge, Milly / Arcelli, Alessandra / Alfieri, Sergio / Calvo, Felipe A / Casadei, Riccardo / Cilla, Savino / Deodato, Francesco / Di Gioia, Giancarmine / Di Marco, Mariacristina / Fuccio, Lorenzo / Bertini, Federica / Guido, Alessandra / Herman, Joseph M / Macchia, Gabriella / Maidment, Bert W / Miller, Robert C / Minni, Francesco / Passoni, Paolo / Valentini, Chiara / Re, Alessia / Regine, William F / Reni, Michele / Falconi, Massimo / Valentini, Vincenzo / Mattiucci, Gian Carlo. ·Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, via Giuseppe Massarenti 9, 40138, Bologna, Italy. · UOC Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Roma, Italy. · Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, via Giuseppe Massarenti 9, 40138, Bologna, Italy. mbuwenge@gmail.com. · Istituto di Clinica Chirurgica, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Roma, Italy. · Department of Oncology, Hospital General Universitario Gregorio Marañón, Complutense University, Madrid, Spain. · Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Bologna, Italy. · Unit of Medical Physics, Fondazione Giovanni Paolo II, Campobasso, Italy. · Radiotherapy Unit, Fondazione Giovanni Paolo II, Campobasso, Italy. · Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. · Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA. · Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA. · IRCCS, Ospedale S. Raffaele, Milan, Italy. · Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. · Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA. · Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital, University "Vita e Salute", Milan, Italy. ·BMC Cancer · Pubmed #31185957.

ABSTRACT: BACKGROUND: To evaluate the impact of radiation dose on overall survival (OS) in patients treated with adjuvant chemoradiation (CRT) for pancreatic ductal adenocarcinoma (PDAC). METHODS: A multicenter retrospective analysis on 514 patients with PDAC (T1-4; N0-1; M0) treated with surgical resection with macroscopically negative margins (R0-1) followed by adjuvant CRT was performed. Patients were stratified into 4 groups based on radiotherapy doses (group 1: < 45 Gy, group 2: ≥ 45 and < 50 Gy, group 3: ≥ 50 and < 55 Gy, group 4: ≥ 55 Gy). Adjuvant chemotherapy was prescribed to 141 patients. Survival functions were plotted using the Kaplan-Meier method and compared through the log-rank test. RESULTS: Median follow-up was 35 months (range: 3-120 months). At univariate analysis, a worse OS was recorded in patients with higher preoperative Ca 19.9 levels (≥ 90 U/ml; p < 0.001), higher tumor grade (G3-4, p = 0.004), R1 resection (p = 0.004), higher pT stage (pT3-4, p = 0.002) and positive nodes (p < 0.001). Furthermore, patients receiving increasing doses of CRT showed a significantly improved OS. In groups 1, 2, 3, and 4, median OS was 13.0 months, 21.0 months, 22.0 months, and 28.0 months, respectively (p = 0.004). The significant impact of higher dose was confirmed by multivariate analysis. CONCLUSIONS: Increasing doses of CRT seems to favorably impact on OS in adjuvant setting. The conflicting results of randomized trials on adjuvant CRT in PDAC could be due to < 45 Gy dose generally used.

2 Article Spot-scanned pancreatic stereotactic body proton therapy: A dosimetric feasibility and robustness study. 2016

Sio, Terence T / Merrell, Kenneth W / Beltran, Chris J / Ashman, Jonathan B / Hoeft, Kathleen A / Miller, Robert C / Whitaker, Thomas J / Wurgler, Stephanie K / Tryggestad, Erik J. ·Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55901, USA; Department of Radiation Oncology, Mayo Clinic Hospital, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA. · Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55901, USA. · Department of Radiation Oncology, Mayo Clinic Hospital, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA. · Department of Radiation Oncology, Mayo Clinic Hospital, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA. Electronic address: Tryggestad.Erik@mayo.edu. ·Phys Med · Pubmed #26883369.

ABSTRACT: PURPOSE: We explored the dosimetric potential of spot-scanned stereotactic body proton therapy (SBPT) for pancreatic cancer. METHODS: We compared SBPT to stereotactic body intensity-modulated radiotherapy (SB-IMRT) in 10 patients. We evaluated 3 variables in SBPT planning: (1) 4 and 6 mm spot size; (2) single vs. multi-field optimization (SFO vs. MFO); and (3) optimization target volume (OTV) expansion. Robustness analysis was performed with unidirectional isocenter shifts of ±3 mm in x, y, and z and ±3% stopping power uncertainties. RESULTS: SBPT plans had lower V10Gy for the stomach and small and large bowels. Under static robustness, a 5 mm OTV and SFO-6 mm spot size represented the best compromise between target and normal structure. A 4-mm spot-size and 3 mm OTV resulted in significant target underdosing with deformable dose accumulation analysis. CONCLUSIONS: This study provides a critical basis for clinical translation of spot size, optimization technique, and OTV expansion for pancreatic SBPT.

3 Article Predictors of Locoregional Failure and Impact on Overall Survival in Patients With Resected Exocrine Pancreatic Cancer. 2016

Merrell, Kenneth W / Haddock, Michael G / Quevedo, J Fernando / Harmsen, William S / Kendrick, Michael L / Miller, Robert C / Hallemeier, Christopher L. ·Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. · Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota. · Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota. · Department of General Surgery, Mayo Clinic, Rochester, Minnesota. · Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. Electronic address: hallemeier.christopher@mayo.edu. ·Int J Radiat Oncol Biol Phys · Pubmed #26867884.

ABSTRACT: PURPOSE: Resection of exocrine pancreatic cancer is necessary for cure, but locoregional and distant relapse is common. We evaluated our institutional experience to better understand risk factors for locoregional failure (LRF) and its impact on overall survival (OS). METHODS AND MATERIALS: We reviewed 1051 consecutive patients with nonmetastatic exocrine pancreatic cancer who underwent resection at our institution between March 1987 and January 2011. Among them, 458 had adequate follow-up and evaluation for study inclusion. All patients received adjuvant chemotherapy (n=80 [17.5%]) or chemoradiation therapy (n=378 [82.5%]). Chemotherapy and chemoradiation therapy most frequently consisted of 6 cycles of gemcitabine and 50.4 Gy in 28 fractions with concurrent 5-fluorouracil, respectively. Locoregional control (LRC) and OS were estimated with the Kaplan-Meier method. Univariate and multivariate analyses were performed with Cox proportional hazards regression models incorporating propensity score. RESULTS: Median patient age was 64.5 years (range: 29-88 years). Median follow-up for living patients was 84 months (range: 6-300 months). Extent of resection was R0 (83.8%) or R1 (16.2%). Overall crude incidence of LRF was 17% (n=79). The 5-year LRC for patients with and without radiation therapy was 80% and 68%, respectively (P=.003; hazard ratio [HR]: 0.45; 95% confidence interval [CI]: 0.28-0.76). Multivariate analysis, incorporating propensity score, indicated radiation therapy (P<.0001; HR: 0.23; 95% CI: 0.12-0.42) and positive lymph node ratio of ≥0.2 (P=.02; HR: 1.78; 95% CI: 1.10-2.9) were associated with LRC. In addition, LRF was associated with worse OS (P<.0001; HR: 5.0; 95% CI: 3.9-6.3). CONCLUSIONS: In our analysis of 458 patients with resected pancreatic cancer, positive lymph node ratio of ≥0.2 and no adjuvant chemoradiation therapy were associated with increased LRF risk. LRF was associated with poor OS. Radiation therapy should be considered as adjuvant locoregional treatment following pancreatic cancer resection.

4 Article Adjuvant Chemoradiation in Pancreatic Cancer: A Pooled Analysis in Elderly (≥75 years) Patients. 2015

Mattiucci, Gian-Carlo / Falconi, Massimo / VAN Stiphout, Ruud G P M / Alfieri, Sergio / Calvo, Felipe A / Herman, Joseph M / Maidment, Bert W / Miller, Robert C / Regine, William F / Reni, Michele / Sharma, Navesh / Partelli, Stefano / Genovesi, Domenico / Balducci, Mario / Deodato, Francesco / Valentini, Vincenzo / Morganti, Alessio G. ·Department of Radiotherapy, Sacro Cuore Catholic University, Rome, Italy gcmattiucci@rm.unicatt.it. · Department of Surgery, University of Verona, Verona, Italy. · Department of Radiation Oncology (MAASTRO), GROW, University Medical Centre, Maastricht, the Netherlands. · Department of Surgery, Sacro Cuore Catholic University, Rome, Italy. · Department of Oncology, Gregorio Marañón General Hospital, Complutense University, Madrid, Spain. · Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A. · Department of Radiation Oncology, University of Virginia, Charlottesville, VA, U.S.A. · Department of Radiation Oncology, Mayo Clinic, Rochester, MN, U.S.A. · Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, U.S.A. · Department of Oncology, S. Raffaele Scientific Institute, Milan, Italy. · Department of Radiotherapy, Sacro Cuore Catholic University, Rome, Italy. · Department of Radiotherapy, SS Annunziata Hospital, G. D'Annunzio University, Chieti, Italy. · Unit of Radiotherapy, Unit of General Oncology, Giovanni Paolo II Foundation, Campobasso, Italy. ·Anticancer Res · Pubmed #26026108.

ABSTRACT: AIM: To determine the impact of postoperative chemoradiation (POCR) on overall survival (OS) after resection of pancreatic adenocarcinoma (PAC) in elderly (≥75 years) patients. MATERIALS AND METHODS: A multi-center retrospective review of 1248 patients who underwent complete resection with macroscopically negative margins (R0-1) for invasive PAC was performed. Exclusion criteria included age <75 years, metastatic or unresectable disease at surgery, macroscopic residual disease (R2), treatment with intraoperative radiotherapy (IORT) and postoperative death. RESULTS: A total of 98 patients were included in the analysis (males=39.8%, females=60.2%; R1 resections=33.7%; pN1=61.2%); 63 patients received POCR and 26 patients received adjuvant chemotherapy alone. The median follow-up was 25.6 months. The mean age for the entire cohort of patients was 78.1±2.9 (SD) years. No differences were observed between patients receiving or not receiving POCR in terms of age (p=0.081), tumor diameter (p=0.412), rate of R1 resection (p=0.331) and incidence of lymph node-positive disease (p=0.078). The only factor predicting an improved OS was POCR. The median OS was 69.0 months in patients treated by POCR and 23.0 months in patients treated without POCR (p=0.008). Even by Cox multivariate analysis, the only significant predictor of OS was POCR (hazard ratio=0.449; 95% confidence interval=0.212-0.950; p=0.036). CONCLUSION: The study represents the first comparative approach on POCR in elderly patients after resection of PAC. OS was higher in patients who received POCR. Further analyses are warranted to evaluate the toxicity rate/grade and the impact of POCR on patient quality of life.

5 Article Multi-institutional pooled analysis on adjuvant chemoradiation in pancreatic cancer. 2014

Morganti, Alessio G / Falconi, Massimo / van Stiphout, Ruud G P M / Mattiucci, Gian-Carlo / Alfieri, Sergio / Calvo, Felipe A / Dubois, Jean-Bernard / Fastner, Gerd / Herman, Joseph M / Maidment, Bert W / Miller, Robert C / Regine, William F / Reni, Michele / Sharma, Navesh K / Ippolito, Edy / Valentini, Vincenzo. ·Department of Radiotherapy, Università Cattolica S. Cuore, Rome, Italy; Unit of Radiotherapy, Unit of General Oncology, Fondazione Giovanni Paolo II, Campobasso, Italy. · Department of Surgery, University of Verona, Verona, Italy. · Department of Radiation Oncology (MAASTRO), GROW, University Medical Centre Maastricht, The Netherlands. · Department of Radiotherapy, Università Cattolica S. Cuore, Rome, Italy. Electronic address: gcmattiucci@rm.unicatt.it. · Department of Surgery, Università Cattolica S. Cuore, Rome, Italy. · Department of Oncology, Hospital General Universitario Gregorio Marañón, Complutense University, Madrid, Spain. · Département de Radiothérapie, CRLC, Montpellier Cedex, France. · Department of Radiotherapy, PMU, Salzburg, Austria. · Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland. · Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia. · Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. · Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland. · Department of Oncology, S. Raffaele Scientific Institute, Milan, Italy. · Department of Radiation Oncology, University Campus Biomedico, Roma, Italy. · Department of Radiotherapy, Università Cattolica S. Cuore, Rome, Italy. ·Int J Radiat Oncol Biol Phys · Pubmed #25220717.

ABSTRACT: PURPOSE: To determine the impact of chemoradiation therapy (CRT) on overall survival (OS) after resection of pancreatic adenocarcinoma. METHODS AND MATERIALS: A multicenter retrospective review of 955 consecutive patients who underwent complete resection with macroscopically negative margins (R0-1) for invasive carcinoma (T1-4; N0-1; M0) of the pancreas was performed. Exclusion criteria included metastatic or unresectable disease at surgery, macroscopic residual disease (R2), treatment with intraoperative radiation therapy (IORT), and a histological diagnosis of no ductal carcinoma, or postoperative death (within 60 days of surgery). In all, 623 patients received postoperative radiation therapy (RT), 575 patients received concurrent chemotherapy (CT), and 462 patients received adjuvant CT. RESULTS: Median follow-up was 21.0 months. Median OS after adjuvant CRT was 39.9 versus 24.8 months after no adjuvant CRT (P<.001) and 27.8 months after CT alone (P<.001). Five-year OS was 41.2% versus 24.8% with and without postoperative CRT, respectively. The positive impact of CRT was confirmed by multivariate analysis (hazard ratio [HR] = 0.72; confidence interval [CI], 0.60-0.87; P=.001). Adverse prognostic factors identified by multivariate analysis included the following: R1 resection (HR = 1.17; CI = 1.07-1.28; P<.001), higher pT stage (HR = 1.23; CI = 1.11-1.37; P<.001), positive lymph nodes (HR = 1.27; CI = 1.15-1.41; P<.001), and tumor diameter >20 mm (HR = 1.14; CI = 1.05-1.23; P=.002). Multivariate analysis also showed a better prognosis in patients treated in centers with >10 pancreatic resections per year (HR = 0.87; CI = 0.78-0.97; P=.014) CONCLUSION: This study represents the largest comparative study on adjuvant therapy in patients after resection of carcinoma of the pancreas. Overall survival was better in patients who received adjuvant CRT.

6 Article Clinical outcomes and dosimetric considerations using stereotactic body radiotherapy for abdominopelvic tumors. 2012

Barney, Brandon M / Olivier, Kenneth R / Macdonald, O Kenneth / Fong de Los Santos, Luis E / Miller, Robert C / Haddock, Michael G. ·Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA. barney.brandon@mayo.edu ·Am J Clin Oncol · Pubmed #21659830.

ABSTRACT: PURPOSE/OBJECTIVES: To present clinical outcomes, early toxicity, and dosimetric constraints for patients undergoing stereotactic body radiation therapy (SBRT) for abdominal or pelvic tumors. MATERIALS AND METHODS: From May 2008 to February 2010, 47 patients with 50 lesions in proximity to hollow viscous organs at risk, including stomach, duodenum, small bowel, and colon, underwent SBRT at Mayo Clinic. Treated sites included liver (21), lymph node (14), adrenal gland (6), intramuscular (4), pancreas (3), and spleen (2). Treatment planning was performed with full body immobilization and 4-dimensional computed tomography (CT)-based planning with daily cone-beam CT or stereoscopic kV imaging for pretreatment image guidance. SBRT was delivered in 1 to 5 consecutive daily fractions in a single week. The most commonly prescribed dose was 50 Gy in 5 fractions (median 45 Gy, range: 20 to 60 Gy). Toxicities were scored by CTCAE v.3. Local failure was defined as per the Response Evaluation Criteria in Solid Tumors. RESULTS: Median follow-up was 12 months (range: 2 to 28 mo). Tumor responses of the 48 target lesions evaluable by Response Evaluation Criteria in Solid Tumor were complete response in 18 lesions (36%), partial response in 12 lesions (24%), stable disease in 12 lesions (24%), and progressive disease in 6 lesions (12%). Kaplan-Meier estimates of local control, overall survival, and freedom from metastasis at 6 and 12 months were 98%, 90%, and 63%, and 87%, 62%, 37%, respectively. Treatment was well-tolerated acutely without reported grade ≥3 toxicity. Five grade 3 late toxicities were reported, and 1 patient died of complications from duodenal perforation 11 months after SBRT. No dose correlation with toxicity could be established. CONCLUSIONS: SBRT is a practical treatment option for patients with abdominopelvic tumors. Relapse typically occurs outside treatment fields, and most patients achieve a favorable response. The dose constraints used in this cohort of patients was associated with acceptable early treatment-related toxicity.

7 Article Preoperative CA 19-9 level is an important prognostic factor in patients with pancreatic adenocarcinoma treated with surgical resection and adjuvant concurrent chemoradiotherapy. 2011

Hallemeier, Christopher L / Botros, Maikel / Corsini, Michele M / Haddock, Michael G / Gunderson, Leonard L / Miller, Robert C. ·Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA. miller.robert@mayo.edu ·Am J Clin Oncol · Pubmed #21150564.

ABSTRACT: OBJECTIVES: To evaluate preoperative CA 19-9 level as a prognostic factor in patients with resected adenocarcinoma of the pancreas. METHODS: We retrospectively reviewed the cases of consecutive patients with pancreatic adenocarcinoma who had CA 19-9 measured preoperatively and underwent potentially curative resection at Mayo Clinic from September 1995 to January 2005. Patients who died within 30 days of resection were excluded. RESULTS: Search of our database identified 226 consecutive patients who met all the inclusion criteria. Adjuvant therapy was concurrent chemoradiotherapy (CCRT) in 122 patients, CCRT followed by chemotherapy in 23 patients, chemotherapy alone in 6 patients, and none in 69 patients. Median follow-up for surviving patients was 2.1 years. Median survival in all patients was 1.6 years. Patients with a high preoperative CA 19-9 level (defined as ≥180 U/mL) had a greater chance of having pathologic T3-T4 disease (P=0.03), positive lymph nodes (P=0.01), and histologic grade 3 or 4 (P=0.02). In multivariate analysis, a high preoperative CA 19-9 level (P=0.006) and R1-R2 margin status (P=0.03) were associated with decreased survival. Overall survival was increased for patients who received adjuvant CCRT (vs. those who did not; P=0.002) and for patients with high preoperative CA 19-9 level who received adjuvant CCRT (vs. those who did not; P<0.001). CONCLUSIONS: In patients with resected adenocarcinoma of the pancreas, high preoperative CA 19-9 level was associated with adverse pathologic features and poorer survival. Adjuvant CCRT was associated with a significant survival benefit in patients with high preoperative CA 19-9 but not in those with low CA 19-9.

8 Article Adjuvant chemoradiotherapy for resected pancreas cancer. 2010

Iott, Matthew / Neben-Wittich, Michelle / Quevedo, J Fernando / Miller, Robert C. ·Matthew Iott, Michelle Neben-Wittich, Robert C Miller, Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States. ·World J Gastrointest Surg · Pubmed #21160900.

ABSTRACT: The purpose of this article is to review pertinent literature assessing the evidence regarding adjuvant chemoradiotherapy for adenocarcinoma of the pancreas following curative resection. This review looks at randomized controlled studies with the emphasis on adjuvant chemoradiotherapy. In assessing the evidence from the studies reviewed in this article, the trials have been grouped according to the positive or negative results for or against adjuvant treatment. In addition, data from two large, single-institution studies affirming the role for adjuvant chemoradiotherapy has been included. Understanding the evidence from all of the randomized studies is important in shaping current practice recommendations for adjuvant therapy of surgically resected pancreas cancer. Adjuvant chemoradiotherapy following surgery is the current approach at many cancer treatment centers in the United States. In Europe, chemotherapy alone is the preferred adjuvant therapy. However, the type of adjuvant treatment recommended remains controversial due to conflicting study results. The debate will likely continue. Current practice should be based on the weight of evidence available at this time, which is in favor of adjuvant chemotherapy with chemoradiotherapy.

9 Article Mayo Clinic experience with very rare exocrine pancreatic neoplasms. 2010

Mansfield, Aaron / Tafur, Alfonso / Smithedajkul, Patrick / Corsini, Michele / Quevedo, Fernando / Miller, Robert. ·Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA. ·Pancreas · Pubmed #20622706.

ABSTRACT: OBJECTIVES: Limited data are available to guide the management of very rare exocrine neoplasms of the pancreas (VREP). Available evidence suggests that VREP have different risk factors and prognoses from those of adenocarcinoma of the pancreas. The primary objectives for this study were to determine the survival, comorbidities, and response to treatment of patients seen at Mayo Clinic with VREP. METHODS: We reviewed patients from 1975 to 2005 who had VREP and compared them to patients with adenocarcinomas that were matched for TNM, grade, and decade of treatment. RESULTS: Sixty-six patients with VREP were identified. The most commonly identified neoplasms were acinar cell carcinoma (n = 15), small cell carcinoma (n = 12), and squamous cell carcinoma (n = 8). Abdominal discomfort and jaundice were the most common presenting symptoms. The median overall survival for patients with VREP, 10.4 months (range, 3.7-23 months), was better than that for matched controls, 8.2 months (range, 4-15.4 months) (P = 0.01). There was no difference in the survival of patients with stage 4 disease between cases, 8 months (range, 2.3-21.8 months), and controls, 6.7 months (range, 2.3-10.8 months) (P = 0.17). CONCLUSIONS: We present one of the largest series of VREP to date. The overall survival of all patients with VREP was better than matched controls, but no statistical difference was seen between the groups with stage 4 disease.

10 Article Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study. 2010

Hsu, Charles C / Herman, Joseph M / Corsini, Michele M / Winter, Jordan M / Callister, Matthew D / Haddock, Michael G / Cameron, John L / Pawlik, Timothy M / Schulick, Richard D / Wolfgang, Christopher L / Laheru, Daniel A / Farnell, Michael B / Swartz, Michael J / Gunderson, Leonard L / Miller, Robert C. ·Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD, USA. ·Ann Surg Oncol · Pubmed #20087786.

ABSTRACT: BACKGROUND: Survival for pancreatic ductal adenocarcinoma is low, the role of adjuvant therapy remains controversial, and recent data suggest adjuvant chemoradiation (CRT) may decrease survival compared with surgery alone. Our goal was to examine efficacy of adjuvant CRT in resected pancreatic adenocarcinoma compared with surgery alone. MATERIALS AND METHODS: Patients with pancreatic adenocarcinoma at Johns Hopkins Hospital (n = 794, 1993-2005) and Mayo Clinic (n = 478, 1985-2005) following resection who were observed (n = 509) or received adjuvant 5-FU based CRT (median dose 50.4 Gy; n = 583) were included. Cox survival and propensity score analyses assessed associations with overall survival. Matched-pair analysis by treatment group (1:1) based on institution, age, sex, tumor size/stage, differentiation, margin, and node positivity with N = 496 (n = 248 per treatment arm) was performed. RESULTS: Median survival was 18.8 months. Overall survival (OS) was longer among recipients of CRT versus surgery alone (median survival 21.1 vs. 15.5 months, P < .001; 2- and 5-year OS 44.7 vs. 34.6%; 22.3 vs. 16.1%, P < .001). Compared with surgery alone, adjuvant CRT improved survival in propensity score analysis for all patients by 33% (P < .001), with improved survival when stratified by age, margin, node, and T-stage (RR = 0.57-0.75, P < .05). Matched-pair analysis demonstrated OS was longer with CRT (21.9 vs. 14.3 months median survival; 2- and 5-year OS 45.5 vs. 31.4%; 25.4 vs. 12.2%, P < .001). CONCLUSIONS: Adjuvant CRT is associated with improved survival after pancreaticoduodenectomy. Adjuvant CRT was not associated with decreased survival in any risk group, even in propensity score and matched-pair analyses. Further studies evaluating adjuvant chemotherapy compared with adjuvant chemoradiation are needed to determine the most effective combination of systemic and local-regional therapy to achieve optimal survival results.