(ChemotherapyAdvisor) – Patients with resectable pancreatic head adenocarcinoma who receive initial treatment with neoadjuvant chemoradiation (CRT) followed by surgery have improved overall survival at a significantly lower cost than those treated with surgery first, a study presented at the ASCO 2012 Gastrointestinal Cancer Symposium has found.

Treating patients with neoadjuvant CRT “identifies those who develop early metastases or prohibitive performance status and can be spared an ineffectual or prohibitively morbid operation,” Daniel Erik Abbott, MD, of the University of Texas M. D. Anderson Cancer Center, Houston, TX, and colleagues noted.

Of 164 patients who completed neoadjuvant CRT, 36 (22%) did not proceed to surgery due to metastases in 18 (50%), prohibitive performance status in 17 (47%), and patient choice in 1 (3%). Among those who had surgery first, 116 patients (71%) had definitive resection while 12 (7%) proceeded to laparotomy but were deemed unresectable.

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The surgery first approach cost $95,781 to yield a survival of 8.7 quality-adjusted life months (QALM). In contrast, the neoadjuvant strategy followed by surgery cost $71,416 to achieve 18.8 QALM, they reported.