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ORIGINAL RESEARCH article

Front. Oncol.
Sec. Radiation Oncology
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1473251
This article is part of the Research Topic Recent Developments in Pancreatic Cancer Radiotherapy - Vol II View all 3 articles

Survival benefits of radiotherapy in locally advanced unresectable and metastatic pancreatic cancer: A single-institution cohort and SEER database analysis

Provisionally accepted
Bi y. Cao Bi y. Cao 1Le-Tian Zhang Le-Tian Zhang 1*Chen-Chen Wu Chen-Chen Wu 2*Jing Wang Jing Wang 2*Yang Lin Yang Lin 1*
  • 1 Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing Municipality, China
  • 2 First Affiliated Hospital of Chinese PLA General Hospital, Beijing, Beijing Municipality, China

The final, formatted version of the article will be published soon.

    Background: Chemotherapy (CT) remains the primary treatment for locally advanced unresectable pancreatic cancer (LAUPC) and metastatic pancreatic cancer (MPC). The role of radiotherapy (RT) in these conditions remains unclear. This study compares the outcomes of CT alone versus CT combined with RT (combined-modality therapy [CMT]) in LAUPC and MPC patients. Materials and Methods: We conducted a retrospective analysis of LAUPC and MPC patients treated with either CT or CMT from a single institution and SEER database. Kaplan-Meier curves and Cox hazards models evaluated the association between treatment modalities and overall survival (OS). Propensity score matching (PSM) ensured balanced comparisons. Landmark analysis addressed immortal time bias. Subgroup analyses were based on clinical characteristics. eXtreme Gradient Boosting (XGBoost) and Shapley Additive Explanations (SHAP) assessed outcome prediction and influence of significant predictors.Results: The study included 102 patients receiving CMT and 155 receiving CT at single institution, along with 1733 CMT and 9310 CT patients from the SEER dataset. In the single-institution cohort, CMT showed superior survival compared to CT both before (median OS: 20.5 vs. 11.5 months, hazard ratio [HR]: 0.47, 95% CI: 0.34-0.65, P=0.001) and after PSM (median OS: 22.2 vs. 11.8 months, HR: 0.49, 95% CI: 0.30-0.79, P=0.003). Multivariate analyses confirmed that CMT was independently associated with improved survival both before (HR: 0.54, 95% CI: 0.38-0.77, P=0.001) and after PSM (HR: 0.45, 95% CI: 0.27-0.73, P=0.001). Landmark analysis indicated better OS for patients receiving CMT compared to CT alone. Subgroup analysis revealed an OS benefit for CMT across most subgroups. SHAP value analysis indicated that CMT was the most significant contributor to survival outcomes. SEER database validation confirmed these findings.Conclusions: This study demonstrates that CMT significantly improves OS in LAUPC and MPC patients compared to CT alone. Integrating RT with CT could be beneficial for treating LAUPC and MPC.

    Keywords: Radiotherapy, chemotherapy, locally advanced, Metastatic, Pancreatic Cancer, Surveillance, Epidemiology, and End Results, Overall survival Abbreviations AJCC, American Joint Committee on Cancer, ASCO, American Society of Clinical Oncology

    Received: 30 Jul 2024; Accepted: 28 Aug 2024.

    Copyright: © 2024 Cao, Zhang, Wu, Wang and Lin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Le-Tian Zhang, Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, Beijing Municipality, China
    Chen-Chen Wu, First Affiliated Hospital of Chinese PLA General Hospital, Beijing, 100853, Beijing Municipality, China
    Jing Wang, First Affiliated Hospital of Chinese PLA General Hospital, Beijing, 100853, Beijing Municipality, China
    Yang Lin, Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, Beijing Municipality, China

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