Is Adjuvant 5-FU-Based Chemoradiotherapy for Resectable Pancreatic Adenocarcinoma Beneficial? A Meta-analysis of an Unanswered Question

Amit Khanna, Gail R. Walker, Alan S. Livingstone, Kristopher L. Arheart, Caio Rocha-Lima, Leonidas Koniaris

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

The objective of this study was to determine the effect, if any, on survival of adjuvant 5-FU-based chemoradiotherapy following pancreaticoduodenectomy for pancreatic carcinoma. A systematic review of the published literature was undertaken. Survival estimates were derived from published reports. Five prospective studies (4 level I, 1 level II) with a total of 607 (229 surgery only; 378 surgery-adjuvant) patients followed for survival met selection criteria. Two-year survival ranged from 15%-37% in the surgery only group and 37%-43% in the surgery and adjuvant groups. The survival advantage (absolute difference) ranged from 3%-27% and no individual study achieved statistical significance (5%). Although clinical heterogeneity existed in surgery-alone control groups with regard to trial date, no statistical heterogeneity was detected (P = 0.459, χ2 test), allowing pooling of survival data. Using a fixed effects model, the summary estimate showed an absolute 2-year survival benefit with adjuvant therapy of 12% (95% CI, 3%-21%, P = 0.011). Trials after 1997 (n = 3) indicated a survival benefit of 8% to patients receiving adjuvant therapy (95% CI, -3-18%, P = 0.145). The result was not statistically significant, and there was no evidence of heterogeneity (P = 0.626, χ2 test). Summary estimates were unchanged when the analysis was performed with a random effects model. 5-FU based chemotherapy with radiotherapy given after resection imparts a small overall survival benefit of 2 years. The benefit of 5-FU-based adjuvant therapy, however, has declined in recent years, and its significance remains unproven in the context of current diagnostic and surgical practice.

Original languageEnglish (US)
Pages (from-to)689-697
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume10
Issue number5
DOIs
StatePublished - May 2006
Externally publishedYes

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Chemoradiotherapy
Fluorouracil
Meta-Analysis
Adenocarcinoma
Survival
Pancreaticoduodenectomy
Patient Selection
Radiotherapy
Therapeutics
Prospective Studies
Drug Therapy
Control Groups

Keywords

  • adjuvant
  • meta-analysis
  • neoadjuvant
  • Pancreatic cancer
  • prospective randomized

ASJC Scopus subject areas

  • Surgery

Cite this

Is Adjuvant 5-FU-Based Chemoradiotherapy for Resectable Pancreatic Adenocarcinoma Beneficial? A Meta-analysis of an Unanswered Question. / Khanna, Amit; Walker, Gail R.; Livingstone, Alan S.; Arheart, Kristopher L.; Rocha-Lima, Caio; Koniaris, Leonidas.

In: Journal of Gastrointestinal Surgery, Vol. 10, No. 5, 05.2006, p. 689-697.

Research output: Contribution to journalArticle

Khanna, Amit ; Walker, Gail R. ; Livingstone, Alan S. ; Arheart, Kristopher L. ; Rocha-Lima, Caio ; Koniaris, Leonidas. / Is Adjuvant 5-FU-Based Chemoradiotherapy for Resectable Pancreatic Adenocarcinoma Beneficial? A Meta-analysis of an Unanswered Question. In: Journal of Gastrointestinal Surgery. 2006 ; Vol. 10, No. 5. pp. 689-697.
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abstract = "The objective of this study was to determine the effect, if any, on survival of adjuvant 5-FU-based chemoradiotherapy following pancreaticoduodenectomy for pancreatic carcinoma. A systematic review of the published literature was undertaken. Survival estimates were derived from published reports. Five prospective studies (4 level I, 1 level II) with a total of 607 (229 surgery only; 378 surgery-adjuvant) patients followed for survival met selection criteria. Two-year survival ranged from 15{\%}-37{\%} in the surgery only group and 37{\%}-43{\%} in the surgery and adjuvant groups. The survival advantage (absolute difference) ranged from 3{\%}-27{\%} and no individual study achieved statistical significance (5{\%}). Although clinical heterogeneity existed in surgery-alone control groups with regard to trial date, no statistical heterogeneity was detected (P = 0.459, χ2 test), allowing pooling of survival data. Using a fixed effects model, the summary estimate showed an absolute 2-year survival benefit with adjuvant therapy of 12{\%} (95{\%} CI, 3{\%}-21{\%}, P = 0.011). Trials after 1997 (n = 3) indicated a survival benefit of 8{\%} to patients receiving adjuvant therapy (95{\%} CI, -3-18{\%}, P = 0.145). The result was not statistically significant, and there was no evidence of heterogeneity (P = 0.626, χ2 test). Summary estimates were unchanged when the analysis was performed with a random effects model. 5-FU based chemotherapy with radiotherapy given after resection imparts a small overall survival benefit of 2 years. The benefit of 5-FU-based adjuvant therapy, however, has declined in recent years, and its significance remains unproven in the context of current diagnostic and surgical practice.",
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