Comparative Effectiveness of Chemotherapy Alone Versus Radiotherapy-Based Regimens in Locally Advanced Pancreatic Cancer: A Real-World Multicenter Analysis (PAULA-1)
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 ±...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-06-01
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| Series: | Current Oncology |
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| Online Access: | https://www.mdpi.com/1718-7729/30/6/427 |
| _version_ | 1797595298950807552 |
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| 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 |
| author_facet | 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 |
| author_sort | Alessandra Arcelli |
| collection | DOAJ |
| description | 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, <sub>95%</sub>CI 0.34–0.92, <i>p</i> = 0.022) or SBRT (HR: 0.27, <sub>95%</sub>CI 0.13–0.54, <i>p</i> < 0.001), compared to CHT. CRT (HR: 0.44, <sub>95%</sub>CI 0.28–0.70, <i>p</i> < 0.001) and SBRT (HR: 0.40, <sub>95%</sub>CI 0.22–0.74, <i>p</i> = 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. |
| first_indexed | 2024-03-11T02:35:26Z |
| format | Article |
| id | doaj.art-0506fa795e9f4240a03a8b5b4a574cbb |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-11T02:35:26Z |
| publishDate | 2023-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-0506fa795e9f4240a03a8b5b4a574cbb2023-11-18T09:58:01ZengMDPI AGCurrent Oncology1198-00521718-77292023-06-013065690570310.3390/curroncol30060427Comparative Effectiveness of Chemotherapy Alone Versus Radiotherapy-Based Regimens in Locally Advanced Pancreatic Cancer: A Real-World Multicenter Analysis (PAULA-1)Alessandra Arcelli0Giuseppe Tarantino1Francesco Cellini2Milly Buwenge3Gabriella Macchia4Federica Bertini5Alessandra Guido6Francesco Deodato7Savino Cilla8Valerio Scotti9Maria Elena Rosetto10Igor Djan11Salvatore Parisi12Gian Carlo Mattiucci13Michele Fiore14Pierluigi Bonomo15Liliana Belgioia16Rita Marina Niespolo17Pietro Gabriele18Mariacristina Di Marco19Nicola Simoni20Johnny Ma21Lidia Strigari22Renzo Mazzarotto23Alessio Giuseppe Morganti24Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyDana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USARadioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, 00168 Rome, ItalyRadiation Oncology, Department of Medical and Surgical Sciences—DIMEC, University of Bologna, 40138 Bologna, ItalyRadiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, ItalyRadiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, ItalyRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyRadioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, 00168 Rome, ItalyMedical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, ItalySan Rossore Private Hospital, 56122 Pisa, ItalyRadiotherapy Unit, Ospedale Belcolle, 01100 Viterbo, ItalyInstitute of Oncology Vojvodina, Sremska Kamenica, Medical Faculty, University of Novi Sad, 21204 Novi Sad, SerbiaRadiotherapy Unit, Ospedale Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, ItalyRadioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, 00168 Rome, ItalyResearch Unit of Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, ItalyRadiation Oncology, Azienda Ospedaliero Universitaria Careggi, 50134 Florence, ItalyDepartment of Radiotherapy, IRCCS Ospedale Policlinico San Martino, 16132 Genova, ItalyRadiation Oncology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, ItalyDepartment of Radiotherapy, Fondazione del Piemonte per l’Oncologia (FPO), IRCCS Candiolo, 10060 Candiolo, ItalyOncology Unit, Department of Medical and Surgical Sciences—DIMEC, University of Bologna, S. Orsola-Malpighi Hospital, 40138 Bologna, ItalyRadiotherapy Unit, Azienda Ospedaliera Universitaria, 43126 Parma, ItalyRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyDepartment of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyRadiotherapy Unit, University Hospital, 37126 Verona, ItalyRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyDifferent 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, <sub>95%</sub>CI 0.34–0.92, <i>p</i> = 0.022) or SBRT (HR: 0.27, <sub>95%</sub>CI 0.13–0.54, <i>p</i> < 0.001), compared to CHT. CRT (HR: 0.44, <sub>95%</sub>CI 0.28–0.70, <i>p</i> < 0.001) and SBRT (HR: 0.40, <sub>95%</sub>CI 0.22–0.74, <i>p</i> = 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.https://www.mdpi.com/1718-7729/30/6/427pancreatic cancerchemotherapystereotactic body radiotherapyconventionally fractionated radiotherapychemoradiation |
| spellingShingle | 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 Comparative Effectiveness of Chemotherapy Alone Versus Radiotherapy-Based Regimens in Locally Advanced Pancreatic Cancer: A Real-World Multicenter Analysis (PAULA-1) Current Oncology pancreatic cancer chemotherapy stereotactic body radiotherapy conventionally fractionated radiotherapy chemoradiation |
| title | Comparative Effectiveness of Chemotherapy Alone Versus Radiotherapy-Based Regimens in Locally Advanced Pancreatic Cancer: A Real-World Multicenter Analysis (PAULA-1) |
| title_full | Comparative Effectiveness of Chemotherapy Alone Versus Radiotherapy-Based Regimens in Locally Advanced Pancreatic Cancer: A Real-World Multicenter Analysis (PAULA-1) |
| title_fullStr | Comparative Effectiveness of Chemotherapy Alone Versus Radiotherapy-Based Regimens in Locally Advanced Pancreatic Cancer: A Real-World Multicenter Analysis (PAULA-1) |
| title_full_unstemmed | Comparative Effectiveness of Chemotherapy Alone Versus Radiotherapy-Based Regimens in Locally Advanced Pancreatic Cancer: A Real-World Multicenter Analysis (PAULA-1) |
| title_short | Comparative Effectiveness of Chemotherapy Alone Versus Radiotherapy-Based Regimens in Locally Advanced Pancreatic Cancer: A Real-World Multicenter Analysis (PAULA-1) |
| title_sort | comparative effectiveness of chemotherapy alone versus radiotherapy based regimens in locally advanced pancreatic cancer a real world multicenter analysis paula 1 |
| topic | pancreatic cancer chemotherapy stereotactic body radiotherapy conventionally fractionated radiotherapy chemoradiation |
| url | https://www.mdpi.com/1718-7729/30/6/427 |
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