Interferon-based adjuvant chemoradiation for resected pancreatic head cancer long-term follow-up of the Virginia mason protocol

Flavio G. Rocha, Yashushi Hashimoto, L. William Traverso, Russell Dorer, Richard Kozarek, W. Scott Helton, Vincent J. Picozzi

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Objective: To report the long-term impact of adjuvant interferon-based chemoradiation therapy (IFN-CRT) after pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC). Background: In 2003, we reported an actuarial 5-year overall survival (OS) of 55% (22 months median follow-up) using adjuvant IFN-CRT after PD. As the original cohort is now10 years distant fromPD,we sought to examine their actual survival, describe patterns of recurrence, and determine prognostic factors. Methods: From 1995 to 2002, 43 patients underwent PD for PDAC and received adjuvant IFN-CRT consisting of external-beam irradiation, continuous 5-fluorouracil infusion, weekly intravenous bolus cisplatin, and subcutaneous interferon-a. Survival was calculated by the method of Kaplan and Meier, and prognostic factors were compared using a log-rank test and a Cox proportional hazards model. Results: With all patients at least 10 years from PD, the 5-year actual survival was 42% and 10-year actual survival was 28% with median OS of 42 months (95% confidence interval: 22-110 months). Nine patients survived beyond 10 years with 7 currently alive without evidence of disease. Initial recurrence included 4 local, 17 distant, and 4 combined sites at a median of 25 months. IFN-CRT was interrupted in 70% of patients because of grade 3 or 4 toxicity, whereas 42% of patients required hospitalization. Adverse prognostic factors included lymph node ratio of 50% or more, Eastern Cooperative Oncology Group performance status of 1 or higher, and IFN-CRT treatment interruption. Conclusions: Adjuvant IFN-CRT after PD can provide long-term survival in resected PDAC. Further studies should focus on patient and tumor factors to maximize benefit and minimize toxicity.

Original languageEnglish (US)
Pages (from-to)376-384
Number of pages9
JournalAnnals of surgery
Volume263
Issue number2
DOIs
StatePublished - 2016
Externally publishedYes

Keywords

  • Adjuvant therapy
  • Chemoradiation
  • Interferon
  • Pancreatic cancer
  • Pancreaticoduodenectomy

ASJC Scopus subject areas

  • Surgery

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