Postoperative complications after resection of borderline resectable and locally advanced pancreatic cancer: The impact of neoadjuvant chemotherapy with conventional radiation or stereotactic body radiation therapy

Alex B Blair; Lauren M Rosati; Neda Rezaee; Georgios Gemenetzis; Lei Zheng; Ralph H Hruban; John L Cameron; Matthew J Weiss; Christopher L Wolfgang; Joseph M Herman; Jin He

doi:10.1016/j.surg.2017.11.027

Postoperative complications after resection of borderline resectable and locally advanced pancreatic cancer: The impact of neoadjuvant chemotherapy with conventional radiation or stereotactic body radiation therapy

Surgery. 2018 May;163(5):1090-1096. doi: 10.1016/j.surg.2017.11.027. Epub 2018 Mar 12.

Authors

Affiliations

¹ Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA; The Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA; The Sol Goldman Pancreatic Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA.
² The Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA; The Sol Goldman Pancreatic Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA; Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD, USA.
³ The Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA; The Sol Goldman Pancreatic Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA; Department of Oncology, Johns Hopkins Hospital, Baltimore, MD, USA.
⁴ The Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA; The Sol Goldman Pancreatic Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA; Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA.
⁵ Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA.
⁶ Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA; The Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA; The Sol Goldman Pancreatic Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: jhe11@jhmi.edu.

Abstract

Background: The impact of neoadjuvant stereotactic body radiation therapy on postoperative complications for patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma remains unclear. Limited studies have compared neoadjuvant stereotactic body radiation therapy versus conventional chemoradiation therapy. A retrospective study was performed to determine if perioperative complications were different among patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma receiving neoadjuvant stereotactic body radiation therapy or chemoradiation therapy.

Methods: Patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma who underwent neoadjuvant chemotherapy with stereotactic body radiation therapy or chemoradiation therapy followed by pancreatectomy at the Johns Hopkins Hospital between 2008 and 2015 were included. Predictive factors for severe complications (Clavien grade ≥ III) were assessed by univariate and multivariate analyses.

Results: A total of 168 patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma underwent neoadjuvant chemotherapy and RT followed by pancreatectomy. Sixty-one (36%) patients underwent stereotactic body radiation therapy and 107 (64%) patients received chemoradiation therapy. Compared with the chemoradiation therapy cohort, the neoadjuvant stereotactic body radiation therapy cohort was more likely to have locally advanced pancreatic ductal adenocarcinoma (62% vs 43% P = .017) and require a vascular resection (54% vs 37%, P = .027). Multiagent chemotherapy was used more commonly in the stereotactic body radiation therapy cohort (97% vs 75%, P < .001). Postoperative complications (Clavien grade ≥ III 23% vs 28%, P = .471) were similar between stereotactic body radiation therapy and chemoradiation therapy cohort. No significant difference in postoperative bleeding or infection was noted in either group.

Conclusion: Compared with chemoradiation therapy, neoadjuvant stereotactic body radiation therapy appears to offer equivalent rates of perioperative complications in patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma despite a greater percentage of locally advanced disease and more complex operative treatment.

Publication types

Comparative Study
Research Support, N.I.H., Extramural

MeSH terms

Aged
Baltimore / epidemiology
Carcinoma, Pancreatic Ductal / therapy*
Female
Humans
Male
Middle Aged
Neoadjuvant Therapy
Pancreatectomy*
Pancreatic Neoplasms / therapy*
Postoperative Complications / epidemiology*
Radiosurgery*
Retrospective Studies

Abstract

Publication types

MeSH terms

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