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Effect of palliative surgery, chemotherapy, and radiation in stage IV pancreatic cancer
Journal of Clinical Oncology (2017)
  • Brooke Vuong, Providence St. Joseph Health
  • Ahmed Dehal, Providence St. Joseph Health
  • Amanda N. Graff-Baker, Providence St. Joseph Health
  • Shu-Ching Chang, Providence St. Joseph Health
  • Leland Foshag, Providence St. Joseph Health
  • Anton J. Bilchik, Providence St. Joseph Health
  • Melanie Goldfarb, Providence St. Joseph Health
Despite significant advances in multi-modality treatment for pancreatic adenocarcinoma (PC), prognosis for stage IV PC remains poor. While reducing suffering and optimizing quality of life are the primary goals of palliative therapies, these interventions may extend overall survival. We examined the impact on survival when aggressive palliative treatments including surgery, chemotherapy, or radiation were employed in end-of-life care. 

The 2004-2014 National Cancer Data Base (NCDB) was queried to identify patients with stage IV PC that did not undergo primary surgical resection. Univariate (Kaplan Meier and log-rank) and multivariable (Cox proportional hazard) analyses were used to assess the associations between patient characteristics, use of palliative therapies, and overall survival. 

Of 72,736 patients identified with metastatic stage IV PC, 2,097 (3%) underwent surgical palliation (ST), 5,615 (8%) received palliative chemotherapy (CT), 940 (1%) received palliative radiation (RT), 1,163 (2%) received multimodality treatment (MMT), and 62,921 (87%) had no aggressive palliative intervention (NT). The choice of palliative therapy, if any, was influenced by all demographic and tumor variables except for gender (all p < 0.001). Median OS was greatest after CT (5.09 months, p < 0.001) compared to any other modality (NT: 3.45months, ST: 3.71months, RT: 3.25months, MMT: 4.47months). This remained true regardless of age, gender, race/ethnicity, insurance, and facility type. After adjusting for all demographic and tumor factors, use of CT decreased the annual risk of death by 20% (HR = 0.8; 95%CI [0.77, 0.82]) and MMT by 10% (HR = 0.9; 95%CI [0.84, 0.96]). Employment of RT increased risk of death by 9% (HR = 1.09; 95%CI [1.01, 1.17]) and ST did not affect OS (HR = 1.01; 95%CI [0.96,1.06]). 

Despite advances in palliative treatments, Stage IV PC arries a dismal prognosis. Palliative RT may shorten survival. Equivalent survival for ST versus NT suggests that this may be beneficial in the appropriate patient. Palliative CT independently improved survival by approximately 6 weeks and should be considered in patients that want to extend survival and can tolerate the toxicity
Publication Date
DOI: 10.1200/JCO.2017.35.15_suppl.e15707
Citation Information
Brooke Vuong, Ahmed Dehal, Amanda N. Graff-Baker, Shu-Ching Chang, et al.. "Effect of palliative surgery, chemotherapy, and radiation in stage IV pancreatic cancer" Journal of Clinical Oncology Vol. 35 Iss. 15S (2017) ISSN: 0732-183X
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