학술논문
Comparative Effectiveness of Chemotherapy Alone Versus Radiotherapy-Based Regimens in Locally Advanced Pancreatic Cancer: A Real-World Multicenter Analysis (PAULA-1)
Document Type
article
Author
Alessandra Arcelli; Giuseppe Tarantino; Francesco Cellini; Milly Buwenge; Gabriella Macchia; Federica Bertini; Alessandra Guido; Francesco Deodato; Savino Cilla; Valerio Scotti; Maria Elena Rosetto; Igor Djan; Salvatore Parisi; Gian Carlo Mattiucci; Michele Fiore; Pierluigi Bonomo; Liliana Belgioia; Rita Marina Niespolo; Pietro Gabriele; Mariacristina Di Marco; Nicola Simoni; Johnny Ma; Lidia Strigari; Renzo Mazzarotto; Alessio Giuseppe Morganti
Source
Current Oncology, Vol 30, Iss 6, Pp 5690-5703 (2023)
Subject
Language
English
ISSN
30060427
1718-7729
1198-0052
1718-7729
1198-0052
Abstract
Different options for locally advanced pancreatic cancer (LAPC) are available based on international guidelines: chemotherapy (CHT), chemoradiation (CRT), and stereotactic body radiotherapy (SBRT). However, the role of radiotherapy is debated in LAPC. We retrospectively compared CHT, CRT, and SBRT ± CHT in a real-world setting in terms of overall survival (OS), local control (LC), and distant metastasis-free survival (DMFS). LAPC patients from a multicentric retrospective database were included (2005–2018). Survival curves were calculated using the Kaplan–Meier method. Multivariable Cox analysis was performed to identify predictors of LC, OS, and DMFS. Of the 419 patients included, 71.1% were treated with CRT, 15.5% with CHT, and 13.4% with SBRT. Multivariable analysis showed higher LC rates for CRT (HR: 0.56, 95%CI 0.34–0.92, p = 0.022) or SBRT (HR: 0.27, 95%CI 0.13–0.54, p < 0.001), compared to CHT. CRT (HR: 0.44, 95%CI 0.28–0.70, p < 0.001) and SBRT (HR: 0.40, 95%CI 0.22–0.74, p = 0.003) were predictors of prolonged OS with respect to CHT. No significant differences were recorded in terms of DMFS. In selected patients, the addition of radiotherapy to CHT is still an option to be considered. In patients referred for radiotherapy, CRT can be replaced by SBRT considering its duration, higher LC rate, and OS rate, which are at least comparable to that of CRT.