Skip to main content

Main menu

  • Home
  • Current Issue
  • Archive
  • Info for
    • Authors
    • Editorial Policies
    • Subscribers
    • Advertisers
    • Editorial Board
  • Other Publications
    • In Vivo
    • Cancer Genomics & Proteomics
    • Cancer Diagnosis & Prognosis
  • More
    • IIAR
    • Conferences
    • 2008 Nobel Laureates
  • About Us
    • General Policy
    • Contact
  • Other Publications
    • Anticancer Research
    • In Vivo
    • Cancer Genomics & Proteomics

User menu

  • Register
  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
Anticancer Research
  • Other Publications
    • Anticancer Research
    • In Vivo
    • Cancer Genomics & Proteomics
  • Register
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Anticancer Research

Advanced Search

  • Home
  • Current Issue
  • Archive
  • Info for
    • Authors
    • Editorial Policies
    • Subscribers
    • Advertisers
    • Editorial Board
  • Other Publications
    • In Vivo
    • Cancer Genomics & Proteomics
    • Cancer Diagnosis & Prognosis
  • More
    • IIAR
    • Conferences
    • 2008 Nobel Laureates
  • About Us
    • General Policy
    • Contact
  • Visit us on Facebook
  • Follow us on Linkedin
Research ArticleClinical Studies

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

GIAN-CARLO MATTIUCCI, MASSIMO FALCONI, RUUD G.P.M. VAN STIPHOUT, SERGIO ALFIERI, FELIPE. A. CALVO, JOSEPH M. HERMAN, BERT W. MAIDMENT, ROBERT C. MILLER, WILLIAM F. REGINE, MICHELE RENI, NAVESH SHARMA, STEFANO PARTELLI, DOMENICO GENOVESI, MARIO BALDUCCI, FRANCESCO DEODATO, VINCENZO VALENTINI and ALESSIO G. MORGANTI
Anticancer Research June 2015, 35 (6) 3441-3446;
GIAN-CARLO MATTIUCCI
1Department of Radiotherapy, Sacro Cuore Catholic University, Rome, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: gcmattiucci@rm.unicatt.it
MASSIMO FALCONI
2Department of Surgery, University of Verona, Verona, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
RUUD G.P.M. VAN STIPHOUT
3Department of Radiation Oncology (MAASTRO), GROW, University Medical Centre, Maastricht, the Netherlands
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
SERGIO ALFIERI
4Department of Surgery, Sacro Cuore Catholic University, Rome, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
FELIPE. A. CALVO
5Department of Oncology, Gregorio Marañón General Hospital, Complutense University, Madrid, Spain
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
JOSEPH M. HERMAN
6Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
BERT W. MAIDMENT III
7Department of Radiation Oncology, University of Virginia, Charlottesville, VA, U.S.A.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
ROBERT C. MILLER
8Department of Radiation Oncology, Mayo Clinic, Rochester, MN, U.S.A.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
WILLIAM F. REGINE
9Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, U.S.A.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
MICHELE RENI
10Department of Oncology, S. Raffaele Scientific Institute, Milan, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
NAVESH SHARMA
9Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, U.S.A.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
STEFANO PARTELLI
1Department of Radiotherapy, Sacro Cuore Catholic University, Rome, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
DOMENICO GENOVESI
12Department of Radiotherapy, SS Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
MARIO BALDUCCI
1Department of Radiotherapy, Sacro Cuore Catholic University, Rome, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
FRANCESCO DEODATO
13Unit of Radiotherapy, Unit of General Oncology, Giovanni Paolo II Foundation, Campobasso, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
VINCENZO VALENTINI
1Department of Radiotherapy, Sacro Cuore Catholic University, Rome, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
ALESSIO G. MORGANTI
13Unit of Radiotherapy, Unit of General Oncology, Giovanni Paolo II Foundation, Campobasso, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

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.

  • Pancreatic cancer
  • adjuvant
  • aged
  • pooled analysis
  • radiotherapy
  • chemotherapy
  • multicenter study

Pancreatic adenocarcinoma represents the fourth cause of death from cancer in Western countries. Surgical resection remains the only chance of cure, but only a minority of tumors are potentially resectable at diagnosis. Furthermore, even in resectable patients, treatment outcomes remain relatively poor despite complete resection. The cure rates have been modestly improved by the use of adjuvant therapies.

The majority of patients with pancreatic cancer are over the age of 65 years. But this age group is under-represented within clinical trials, and it is unknown whether older patients achieve results similar to younger ones in terms of survival and treatment tolerance. In addition, there exist no clinical trials dedicated to the elderly (1).

In particular, limited data are available on the safety and efficacy of radical pancreatectomy (RP) in elderly patients. It has been observed that there is increased incidence of postoperative mortality and pneumonia after RP among all elderly patients 75 years of age or more, as well as an increased incidence of postoperative complications among patients aged 80 years or more (2). More specifically, these patients have an increased risk of postoperative pancreatic fistula (3). However, it has even been observed that most elderly adults with pancreatic cancer survive longer than one year after RP and more than one third survive longer than two years (4). Hence, even if the rate of complications is increased, it is considered acceptable and it is therefore justified to offer RP to elderly patients who do not have significant comorbidities.

With regard to adjuvant chemotherapy, there are few data on the elderly population. Elderly patients are under-represented in phase III clinical trials, and as a consequence, the efficacy of adjuvant chemotherapy in older patients with pancreatic cancer is not clear (5). Maréchal and colleagues (1) observed that we can only reasonably argue that selected elderly patients with PAC can benefit from curative surgery and postoperative chemotherapy.

Postoperative chemoradiation (POCR), usually associated with adjuvant chemotherapy, is another option for therapy after RP. Although this treatment's role is still debated, several studies have documented its efficacy in improving the prognosis of resected patients. The major randomized trials on POCR did exclude elderly patients. However, the population of older patients seems to be under-represented. In the Gastrointestinal Tumor Study Group GITSG study the median age of patients undergoing POCR was 64 years, with 41% of patients enrolled in the study less than 60 years of age (6, 7). In the European Organization for Research and Treatment of Cancer study the median age in patients undergoing POCR was 59 years (8, 9). Finally, in the European Study Group for Pancreatic Cancer study, the median age was 61 years, with an interquartile range of 54-67 years (10, 11).

Furthermore, only a few retrospective single-institution studies have been published on the results of POCR in elderly patients (12, 13). Accordingly, the purpose of this analysis was to evaluate the impact of POCR on the survival of a population of elderly patients from several Institutions previously treated with RP.

Materials and Methods

Study design and participants. Clinical data (N=1248) from nine different Institutions (Baltimore, Rochester, Montpellier, Madrid, Salzburg, Verona, Campobasso, Milan, and Rome) were pooled for this analysis on an individual patient basis (14). Patients were treated between 1995 and 2008. The following variables were analyzed: age, gender, tumor location (head, body, tail), tumor grade (1-4), microscopically involved surgical margins (no/yes), pathological tumor stage, pathological nodal stage, adjuvant chemotherapy and POCR. Overall survival was the primary objective of the analysis and was calculated from the date of diagnosis. The following exclusion criteria were used: death within 60 days of surgery, neoadjuvant treatment, metastatic disease (M1), different diagnoses other than ductal adenocarcinomas (i.e. ampullary and periampullary tumors, cholangio-carcinoma, duodenal cancer, islet cell tumor and mucinous cystoadenocarcinoma), patients treated with intraoperative radiation therapy (IORT) or experimental pancreatic cancer vaccine therapy, missing data on pathological tumor stage or nodal status. By excluding ineligible patients and patients with missing survival data, 955 patients remained as the reference database. Of the remaining patients, 98 aged 75 years or more were selected for this analysis (Figure 1).

Adjuvant chemoradiation. The details of POCR have been described in detail elsewhere (15-19). In brief, adjuvant external-beam RT was delivered with linear accelerators using multiple-field techniques, with a median RT dose of 50.4 Gy and daily fraction of 1.8 Gy. All patients received a continuous course of radiation therapy without a planned break. Concurrent chemotherapy was based on 5-fluorouracil or capecitabine in most centers; gemcitabine was used in two centers and tegafur in one. Adjuvant chemotherapy was gemcitabine-based in most centers.

Statistical analysis. Statistical analysis was performed with SYSTAT, version 11.0 (SPSS, Chicago, IL, USA). Comparison of means was performed using a t-test for two independent samples. Actuarial survival was calculated using the Kaplan–Meier method (20) and comparisons between survival curves were performed using the log-rank test (21). Multivariate analyses were performed including factors with p<0.1 on univariate (log-rank) analysis, using Cox proportional hazard modeling (22).

Results

Patients' characteristics. The median follow-up time for patients overall was 25.6 months. Demographic data for patients are shown in Table I. The median age for the entire cohort of patients was 78.1±2.9 (SD) years. No differences between patients receiving or not adjuvant chemoradiation were observed in terms of age (78.4±2.9 years versus 77.4±2.8 years; p=0.081), tumor diameter (2.3±0.6 cm versus 2.7±1.2 cm; p=0.412), rate of R1 resection (37.3% versus 31.4%; p=0.331) and incidence of lymph node-positive disease (74.3% versus 54.9%; p= 0.078).

Figure 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1.

Flow-chart of patient selection.

Figure 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 2.

Overall survival of 98 patients with R0-1 resection who received (median survival=69.0 months) or did not receive (median survival=24.0 months; p=0.008) adjuvant chemoradiation.

Overall survival. Table II shows the results of the univariate analysis. The only factor predicting for better overall survival 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) (Figure 2). Table III shows the results of the multivariate Cox analysis. Even by Cox analysis, the only significant predictor of better overall survival was POCR [hazard ratio (HR)=0.449; 95% confidence interval (CI)=0.212-0.950; p=0.036].

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table I.

Characteristics of the patient cohort.

Discussion

Pancreatic ductal adenocarcinoma is a tumor with poor prognosis that frequently affects elderly patients. However, there exists only limited evidence in the literature on the effect of the treatments currently available for this sub-group of patients. In particular, only few studies analyzed the results of RP in elderly patients, showing an increased but acceptable rate of complications (2, 4) and a median survival similar to that of younger patients (3).

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table II.

Univariate analysis including five year overall survival (OS), median survival time and log-rank p-value.

The evidence for adjuvant chemotherapy is even more limited than that on RP. Maréchal and colleagues noted that retrospective studies performed in the non-resectable setting provide some understanding on outcomes in older patients with pancreatic adenocarcinoma. They concluded that selected elderly patients with pancreatic adenocarcinoma can benefit from curative surgery and postoperative chemotherapy as do their younger counterparts, without a significant increase in morbidity and mortality (1).

Nagrial and colleagues assessed a community cohort of 439 patients with a diagnosis of pancreatic ductal adenocarcinoma who underwent operative resection. Overall only 47% of patients received adjuvant therapy. Older patients (aged >70 years) were less likely to receive adjuvant chemotherapy (51.5% vs. 29.8%; p<0.0001) and had a particularly poor outcome when adjuvant chemotherapy was not delivered (median survival=13.1 months; HR=1.89, 95% CI=1.27-2.78, p=0.002). They concluded that increased use of adjuvant therapy in older individuals should be encouraged as they constitute a large proportion of patients with pancreatic cancer (5).

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table III.

Multivariate Cox analysis. Variables are ranked according to their p-value in the Cox analysis. Hazard ratios (HR) with their confidence interval (CI) are reported.

With regard to POCR, the impact on survival outcome in the elderly population was assessed in only a few retrospective single-Institution studies in the literature (12, 13). Therefore, we analyzed our multi-institutional database to evaluate the role of POCR in elderly patients. This multicenter retrospective study showed a significant improvement of overall survival on treatment with POCR as compared to adjuvant chemotherapy alone (p=0.008), which was confirmed by multivariate analysis.

This analysis presents obvious limitations. First of all, this is a retrospective analysis. In particular, there exists no information on patient selection criteria for adjuvant therapy and we lack data on performance status. Therefore, it is possible that patients receiving POCR presented more favorable prognostic factors or were more healthy. In general, the outcomes observed in patients undergoing POCR seem particularly favorable compared to those reported in the POCR arms of randomized trials. Therefore, although the benefit in terms of survival has been confirmed in the multivariate analysis, it is not possible to determine whether patients who received POCR had more favorable characteristics in terms of prognostic factors not considered in the current analysis (such as Eastern Cooperative Oncology Group Performance Status, comorbidity, and baseline CA19-9 values). Furthermore, the analysis only reported overall survival, since data on disease-specific survival were missing. For this specific age group, the results in terms of cause-specific survival may be different from those of overall survival (23). Another limitation of the analysis is the lack of data on toxicity and patterns of failure. Therefore, it is not possible to assess the effect of POCR on local control and disease-free survival. Similarly, it is not possible to weigh the observed survival advantage taking into account toxicity and impact on quality of life of the recorded advantage in terms of survival. Nevertheless, the results seem to justify further studies on adjuvant treatment in elderly patients with PAC. Such studies should strive to report their results in terms of toxicity and quality of life.

To date, the majority of published studies of adjuvant therapies for patients with pancreatic adenocarcinoma (chemotherapy alone and concurrent radiochemotherapy alone or combined in different times with chemotherapy) have aimed to identify the most effective therapy in the overall population of resected patients. Conversely, future studies on adjuvant therapies should attempt to elucidate methods for individualizing treatment based upon patient characteristics (e.g. age and comorbidities); tumor-related variables, such as residual disease, lymph node status and CA19-9 level before and after surgery, as well as biological markers (e.g. Small Mother Against Decapentaplegic, and Secreted Protein Acidic and Rich in Cysteine). A potentially useful method for drawing such conclusions is the development of predictive methods based upon large patient datasets derived from multiple centers (24).

In conclusion, the results of the present analysis showed a positive effect of POCR on overall survival of elderly patients with PAC. Therefore, this treatment should be considered in selected elderly patients, especially those with high risk of local recurrence.

Footnotes

  • ↵* Both Authors share senior authorship.

  • ↵‡ Current affiliation: Department of Surgery, Università Politecnica delle Marche Polytechnic University, Ancona, Italy;

  • ↵§ Current affiliation: Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.

  • Conflicts of Interest

    No actual or potential conflicts of interest exist regarding this article.

  • Received February 28, 2015.
  • Revision received March 18, 2015.
  • Accepted March 20, 2015.
  • Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved

References

  1. ↵
    1. Maréchal R,
    2. Demols A,
    3. Van Laethem JL
    : Adjuvant pharmacotherapy in the management of elderly patients with pancreatic cancer. Drugs Aging 30: 155-165, 2013.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Sukharamwala P,
    2. Thoens J,
    3. Szuchmacher M,
    4. Smith J,
    5. DeVito P
    : Advanced age is a risk factor for postoperative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review. HPB 14: 649-657, 2012.
    OpenUrlPubMed
  3. ↵
    1. Kow AW,
    2. Sadayan NA,
    3. Ernest A,
    4. Wang B,
    5. Chan CY,
    6. Ho CK,
    7. Liau KH
    : Is pancreaticoduodenectomy justified in elderly patients? Surgeon 10: 128-136, 2012.
    OpenUrlPubMed
  4. ↵
    1. Gerstenhaber F,
    2. Grossman J,
    3. Lubezky N,
    4. Itzkowitz E,
    5. Nachmany I,
    6. Sever R,
    7. Ben-Haim M,
    8. Nakache R,
    9. Klausner JM,
    10. Lahat G
    : Pancreaticoduodenectomy in elderly adults: is it justified in terms of mortality, long-term morbidity, and quality of life? J Am Geriatr Soc 61: 1351-1357, 2013.
    OpenUrlPubMed
  5. ↵
    1. Nagrial AM,
    2. Chang DK,
    3. Nguyen NQ,
    4. Johns AL,
    5. Chantrill LA,
    6. Humphris JL,
    7. Chin VT,
    8. Samra JS,
    9. Gill AJ,
    10. Pajic M
    : Adjuvant chemotherapy in elderly patients with pancreatic cancer. Br J Cancer 110: 313-319, 2014.
    OpenUrlPubMed
  6. ↵
    1. Gastrointestinal Tumor Study Group
    : Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer: Gastrointestinal tumor study group. Cancer 59: 2006-2010, 1987.
    OpenUrlCrossRefPubMed
  7. ↵
    1. Kalser MH,
    2. Ellenberg SS
    : Pancreatic cancer: Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 120: 899-903, 1985.
    OpenUrlCrossRefPubMed
  8. ↵
    1. Klinkenbijl JH,
    2. Jeekel J,
    3. Sahmoud T,
    4. van Pel R,
    5. Couvreur ML,
    6. Veenhof CH,
    7. Arnaud JP,
    8. Gonzalez DG,
    9. de Wit LT,
    10. Hennipman A,
    11. Wils J
    : Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: Phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 230: 776-782, 1999.
    OpenUrlCrossRefPubMed
  9. ↵
    1. Garofalo MC,
    2. Regine WF,
    3. Tan MT
    : On statistical re-analysis, the EORTC trial is a positive trial for adjuvant chemoradiation in pancreatic cancer. Ann Surg 244: 332-333, 2006.
    OpenUrlCrossRefPubMed
  10. ↵
    1. Neoptolemos JP,
    2. Dunn JA,
    3. Stocken DD,
    4. Almond J,
    5. Link K,
    6. Beger H,
    7. Bassi C,
    8. Falconi M,
    9. Pederzoli P,
    10. Dervenis C,
    11. Fernandez-Cruz L,
    12. Lacaine F,
    13. Pap A,
    14. Spooner D,
    15. Kerr DJ,
    16. Friess H,
    17. Büchler MW,
    18. European Study Group for Pancreatic Cancer
    : Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: A randomised controlled trial. Lancet 358: 1576-1585, 2001.
    OpenUrlCrossRefPubMed
  11. ↵
    1. Neoptolemos JP,
    2. Stocken DD,
    3. Friess H,
    4. Bassi C,
    5. Dunn JA,
    6. Hickey H,
    7. Beger H,
    8. Fernandez-Cruz L,
    9. Dervenis C,
    10. Lacaine F,
    11. Falconi M,
    12. Pederzoli P,
    13. Pap A,
    14. Spooner D,
    15. Kerr DJ,
    16. Büchler MW,
    17. European Study Group for Pancreatic Cancer
    : A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 350: 1200-1210, 2004.
    OpenUrlCrossRefPubMed
  12. ↵
    1. Horowitz DP,
    2. Hsu CC,
    3. Wang J,
    4. Makary MA,
    5. Winter JM,
    6. Robinson R,
    7. Schulick RD,
    8. Cameron JL,
    9. Pawlik TM,
    10. Herman JM
    : Adjuvant chemoradiation therapy after pancreaticoduodenectomy in elderly patients with pancreatic adenocarcinoma. Int J Radiat Oncol Biol Phys 80: 1391-1397, 2011.
    OpenUrlCrossRefPubMed
  13. ↵
    1. Miyamoto DT,
    2. Mamon HJ,
    3. Ryan DP,
    4. Willett CG,
    5. Ancukiewicz M,
    6. Kobayashi WK,
    7. Blaszkowsky L,
    8. Fernandez-del Castillo C,
    9. Hong TS
    : Outcomes and tolerability of chemoradiation therapy for pancreatic cancer patients aged 75 years or older. Int J Radiat Oncol Biol Phys 77: 1171-1177, 2010.
    OpenUrlCrossRefPubMed
  14. ↵
    1. Morganti AG,
    2. Falconi M,
    3. van Stiphout RGPM,
    4. Mattiucci GC,
    5. Alfieri S,
    6. Calvo FA,
    7. Dubois JB,
    8. Fastner G,
    9. Herman JM,
    10. Maidment BW 3rd.,
    11. Miller RC,
    12. Regine WF,
    13. Reni M,
    14. Sharma NK,
    15. Ippolito E,
    16. Valentini V
    : Multi-institutional pooled analysis on adjuvant chemoradiation in pancreatic cancer. Int J Radiat Oncol Biol Phys Int J Radiat Oncol Biol Phys 90: 911-917, 2014.
    OpenUrl
  15. ↵
    1. Hsu CC,
    2. Herman JM,
    3. Corsini MM,
    4. Winter JM,
    5. Callister MD,
    6. Haddock MG,
    7. Cameron JL,
    8. Pawlik TM,
    9. Schulick RD,
    10. Wolfgang CL,
    11. Laheru DA,
    12. Farnell MB,
    13. Swartz MJ,
    14. Gunderson LL,
    15. Miller RC
    : Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital – Mayo Clinic collaborative study. Ann Surg Oncol 17: 981-990, 2010.
    OpenUrlCrossRefPubMed
    1. Corsini MM,
    2. Miller RC,
    3. Haddock MG,
    4. Donohue JH,
    5. Farnell MB,
    6. Nagorney DM,
    7. Jatoi A,
    8. McWilliams RR,
    9. Kim GP,
    10. Bhatia S,
    11. Iott MJ,
    12. Gunderson LL
    : Adjuvant radiotherapy and chemotherapy for pancreatic carcinoma: the Mayo Clinic experience (1975-2005). J Clin Oncol 26: 3511-3516, 2008.
    OpenUrlAbstract/FREE Full Text
    1. Herman JM,
    2. Swartz MJ,
    3. Hsu CC,
    4. Winter J,
    5. Pawlik TM,
    6. Sugar E,
    7. Robinson R,
    8. Laheru DA,
    9. Jaffee E,
    10. Hruban RH,
    11. Campbell KA,
    12. Wolfgang CL,
    13. Asrari F,
    14. Donehower R,
    15. Hidalgo M,
    16. Diaz LA Jr.,
    17. Yeo C,
    18. Cameron JL,
    19. Schulick RD,
    20. Abrams R
    : Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas: results of a large, prospectively collected database at the Johns Hopkins Hospital. J Clin Oncol 26: 3503-3510, 2008.
    OpenUrlAbstract/FREE Full Text
    1. Valentini V,
    2. Morganti AG,
    3. Macchia G,
    4. Mantini G,
    5. Mattiucci GC,
    6. Brizi MG,
    7. Alfieri S,
    8. Bossola M,
    9. Pacelli F,
    10. Sofo L,
    11. Doglietto G,
    12. Cellini N
    : Intraoperative radiation therapy in resected pancreatic carcinoma: long-term analysis. Int J Radiat Oncol Biol Phys 70: 1094-1099, 2008.
    OpenUrlPubMed
  16. ↵
    1. Morganti AG,
    2. Valentini V,
    3. Macchia G,
    4. Macchia G,
    5. Alfieri S,
    6. Trodella L,
    7. Brizi MG,
    8. Bossola M,
    9. Ziccarelli L,
    10. Doglietto GB,
    11. Cellini N
    : Adjuvant radiotherapy in resectable pancreatic carcinoma. Eur J Surg Oncol 28: 523-530, 2002.
    OpenUrlCrossRefPubMed
  17. ↵
    1. Kaplan FL,
    2. Meier P
    : Nonparametric estimation from incomplete observations. Am J Stat Assoc 53: 457-481, 1958.
    OpenUrlCrossRef
  18. ↵
    1. Peto R,
    2. Peto J
    : Asymptotically efficient rank invariant procedures. J Royal Stat Soc 135: 185-207, 1972.
    OpenUrl
  19. ↵
    1. Cox DR
    : Regression model and life tables. J Royal Stat Soc Series B 34: 187-220, 1972.
    OpenUrl
  20. ↵
    1. Hyder O,
    2. Dodson RM,
    3. Nathan H,
    4. Schneider EB,
    5. Weiss MJ,
    6. Cameron JL,
    7. Cameron JL,
    8. Choti MA,
    9. Makary MA,
    10. Hirose K,
    11. Wolfgang CL,
    12. Herman JM,
    13. Pawlik TM
    : Influence of patient, physician, and hospital factors on 30-day readmission following pancreaticoduodenectomy in the United States. JAMA Surg 148: 1095-1102, 2013.
    OpenUrlCrossRefPubMed
  21. ↵
    1. Lambin P,
    2. van Stiphout RG,
    3. Starmans MH,
    4. Rios-Velazquez E,
    5. Nalbantov G,
    6. Aerts HJ,
    7. Roelofs E,
    8. van Elmpt W,
    9. Boutros PC,
    10. Granone P,
    11. Valentini V,
    12. Begg AC,
    13. De Ruysscher D,
    14. Dekker A
    : Predicting outcomes in radiation oncology – multifactorial decision support systems. Nat Rev Clin Oncol 10: 27-40, 2013.
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

Anticancer Research: 35 (6)
Anticancer Research
Vol. 35, Issue 6
June 2015
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
  • Back Matter (PDF)
  • Ed Board (PDF)
  • Front Matter (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Anticancer Research.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Adjuvant Chemoradiation in Pancreatic Cancer: A Pooled Analysis in Elderly (≥75 years) Patients
(Your Name) has sent you a message from Anticancer Research
(Your Name) thought you would like to see the Anticancer Research web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
13 + 3 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Adjuvant Chemoradiation in Pancreatic Cancer: A Pooled Analysis in Elderly (≥75 years) Patients
GIAN-CARLO MATTIUCCI, MASSIMO FALCONI, RUUD G.P.M. VAN STIPHOUT, SERGIO ALFIERI, FELIPE. A. CALVO, JOSEPH M. HERMAN, BERT W. MAIDMENT, ROBERT C. MILLER, WILLIAM F. REGINE, MICHELE RENI, NAVESH SHARMA, STEFANO PARTELLI, DOMENICO GENOVESI, MARIO BALDUCCI, FRANCESCO DEODATO, VINCENZO VALENTINI, ALESSIO G. MORGANTI
Anticancer Research Jun 2015, 35 (6) 3441-3446;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Reprints and Permissions
Share
Adjuvant Chemoradiation in Pancreatic Cancer: A Pooled Analysis in Elderly (≥75 years) Patients
GIAN-CARLO MATTIUCCI, MASSIMO FALCONI, RUUD G.P.M. VAN STIPHOUT, SERGIO ALFIERI, FELIPE. A. CALVO, JOSEPH M. HERMAN, BERT W. MAIDMENT, ROBERT C. MILLER, WILLIAM F. REGINE, MICHELE RENI, NAVESH SHARMA, STEFANO PARTELLI, DOMENICO GENOVESI, MARIO BALDUCCI, FRANCESCO DEODATO, VINCENZO VALENTINI, ALESSIO G. MORGANTI
Anticancer Research Jun 2015, 35 (6) 3441-3446;
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Materials and Methods
    • Results
    • Discussion
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Does Multidisciplinary Therapy at a Sarcoma Center Improve the Prognosis of Patients With Soft Tissue Sarcoma? A Retrospective Case Study at a Single Institute
  • Clinicopathological Significance and Predictive Value of High Intratumoral Tumor Budding in Patients With Breast Carcinoma Treated With Neoadjuvant Chemotherapy
  • Successful Prevention of Tumour Lysis Syndrome in HER2-positive Breast Cancer: Case Report and Literature Review
Show more Clinical Studies

Similar Articles

Keywords

  • pancreatic cancer
  • adjuvant
  • aged
  • pooled analysis
  • radiotherapy
  • chemotherapy
  • multicenter study
Anticancer Research

© 2023 Anticancer Research

Powered by HighWire