1 Citation (Scopus)

Abstract

Purpose: In the era of intensity-modulation radiation therapy (IMRT), no prospective randomized trial has evaluated the efficacy of IMRT exclusively, such as concurrent chemoradiotherapy (CCRT), sequential induction chemotherapy followed by radiotherapy (CT-RT), and systemic chemotherapy (CT) alone, for treating unresectable pancreatic adenocarcinomas (PAs) without metastasis. Through propensity score matching, we designed a nationwide, population-based, head-to-head cohort study to determine the effects of various treatments on unresectable PAs. Patients and methods: We minimized the confounding effects of various treatment outcomes in patients with unresectable PAs from the Taiwan Cancer Registry database by dividing them as follows: group 1, CCRT; group 2, sequential CT-RT; group 3, nontreatment; and group 4, CT alone. Results: The matching process yielded a final cohort of 2960 patients (740 patients each in groups 1, 2, 3, and 4). In both univariate and multivariate Cox regression analyses, the adjusted hazard ratios (95% confidence interval) derived for the definitive CCRT and sequential CT-RT groups compared with the CT alone group were 0.443 (0.397–0.495) and 0.633 (0.568–0.705), respectively. Conclusions: A combination of IMRT and systemic CT for the treatment of unresectable PAs might increase survival compared with CT alone.

Original languageEnglish
Pages (from-to)326-332
Number of pages7
JournalRadiotherapy and Oncology
Volume129
Issue number2
DOIs
Publication statusPublished - Nov 1 2018

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Intensity-Modulated Radiotherapy
Propensity Score
Adenocarcinoma
Cohort Studies
Drug Therapy
Survival
Population
Chemoradiotherapy
Radiotherapy
Induction Chemotherapy
Taiwan
Registries
Regression Analysis
Databases
Confidence Intervals
Neoplasm Metastasis
Therapeutics

Keywords

  • Chemotherapy alone
  • Concurrent chemoradiotherapy
  • Pancreatic adenocarcinoma
  • Sequential chemoradiotherapy
  • Survival

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

@article{b7508bda924f4ad095c176dc75b06efb,
title = "Intensity-modulated radiotherapy with systemic chemotherapy improves survival in patients with nonmetastatic unresectable pancreatic adenocarcinoma: A propensity score-matched, nationwide, population-based cohort study",
abstract = "Purpose: In the era of intensity-modulation radiation therapy (IMRT), no prospective randomized trial has evaluated the efficacy of IMRT exclusively, such as concurrent chemoradiotherapy (CCRT), sequential induction chemotherapy followed by radiotherapy (CT-RT), and systemic chemotherapy (CT) alone, for treating unresectable pancreatic adenocarcinomas (PAs) without metastasis. Through propensity score matching, we designed a nationwide, population-based, head-to-head cohort study to determine the effects of various treatments on unresectable PAs. Patients and methods: We minimized the confounding effects of various treatment outcomes in patients with unresectable PAs from the Taiwan Cancer Registry database by dividing them as follows: group 1, CCRT; group 2, sequential CT-RT; group 3, nontreatment; and group 4, CT alone. Results: The matching process yielded a final cohort of 2960 patients (740 patients each in groups 1, 2, 3, and 4). In both univariate and multivariate Cox regression analyses, the adjusted hazard ratios (95{\%} confidence interval) derived for the definitive CCRT and sequential CT-RT groups compared with the CT alone group were 0.443 (0.397–0.495) and 0.633 (0.568–0.705), respectively. Conclusions: A combination of IMRT and systemic CT for the treatment of unresectable PAs might increase survival compared with CT alone.",
keywords = "Chemotherapy alone, Concurrent chemoradiotherapy, Pancreatic adenocarcinoma, Sequential chemoradiotherapy, Survival",
author = "Lin, {Yen Kuang} and Hsieh, {Mao Chih} and Chang, {Chia Lun} and Chow, {Jyh Ming} and Yuan, {Kevin Sheng Po} and Wu, {Alexander T.H.} and Wu, {Szu Yuan}",
year = "2018",
month = "11",
day = "1",
doi = "10.1016/j.radonc.2018.07.012",
language = "English",
volume = "129",
pages = "326--332",
journal = "Radiotherapy and Oncology",
issn = "0167-8140",
publisher = "Elsevier Ireland Ltd",
number = "2",

}

TY - JOUR

T1 - Intensity-modulated radiotherapy with systemic chemotherapy improves survival in patients with nonmetastatic unresectable pancreatic adenocarcinoma

T2 - A propensity score-matched, nationwide, population-based cohort study

AU - Lin, Yen Kuang

AU - Hsieh, Mao Chih

AU - Chang, Chia Lun

AU - Chow, Jyh Ming

AU - Yuan, Kevin Sheng Po

AU - Wu, Alexander T.H.

AU - Wu, Szu Yuan

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Purpose: In the era of intensity-modulation radiation therapy (IMRT), no prospective randomized trial has evaluated the efficacy of IMRT exclusively, such as concurrent chemoradiotherapy (CCRT), sequential induction chemotherapy followed by radiotherapy (CT-RT), and systemic chemotherapy (CT) alone, for treating unresectable pancreatic adenocarcinomas (PAs) without metastasis. Through propensity score matching, we designed a nationwide, population-based, head-to-head cohort study to determine the effects of various treatments on unresectable PAs. Patients and methods: We minimized the confounding effects of various treatment outcomes in patients with unresectable PAs from the Taiwan Cancer Registry database by dividing them as follows: group 1, CCRT; group 2, sequential CT-RT; group 3, nontreatment; and group 4, CT alone. Results: The matching process yielded a final cohort of 2960 patients (740 patients each in groups 1, 2, 3, and 4). In both univariate and multivariate Cox regression analyses, the adjusted hazard ratios (95% confidence interval) derived for the definitive CCRT and sequential CT-RT groups compared with the CT alone group were 0.443 (0.397–0.495) and 0.633 (0.568–0.705), respectively. Conclusions: A combination of IMRT and systemic CT for the treatment of unresectable PAs might increase survival compared with CT alone.

AB - Purpose: In the era of intensity-modulation radiation therapy (IMRT), no prospective randomized trial has evaluated the efficacy of IMRT exclusively, such as concurrent chemoradiotherapy (CCRT), sequential induction chemotherapy followed by radiotherapy (CT-RT), and systemic chemotherapy (CT) alone, for treating unresectable pancreatic adenocarcinomas (PAs) without metastasis. Through propensity score matching, we designed a nationwide, population-based, head-to-head cohort study to determine the effects of various treatments on unresectable PAs. Patients and methods: We minimized the confounding effects of various treatment outcomes in patients with unresectable PAs from the Taiwan Cancer Registry database by dividing them as follows: group 1, CCRT; group 2, sequential CT-RT; group 3, nontreatment; and group 4, CT alone. Results: The matching process yielded a final cohort of 2960 patients (740 patients each in groups 1, 2, 3, and 4). In both univariate and multivariate Cox regression analyses, the adjusted hazard ratios (95% confidence interval) derived for the definitive CCRT and sequential CT-RT groups compared with the CT alone group were 0.443 (0.397–0.495) and 0.633 (0.568–0.705), respectively. Conclusions: A combination of IMRT and systemic CT for the treatment of unresectable PAs might increase survival compared with CT alone.

KW - Chemotherapy alone

KW - Concurrent chemoradiotherapy

KW - Pancreatic adenocarcinoma

KW - Sequential chemoradiotherapy

KW - Survival

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