Abstract
BackgroundFactors associated with long-term survival in gemcitabine-concurrent proton radiotherapy (GPT) for non-metastatic, locally advanced pancreatic cancer (LAPC) remain unclear. This study aimed to determine the factors associated with long-term survival in GPT for non-metastatic LAPC.MethodsThe medical records of 123 patients with LAPC treated with GPT between February 2009 and December 2019 at Hyogo Ion Beam Medical Center were retrospectively reviewed to assess the factors associated with long-term survival outcomes.ResultsThe median overall survival of the total cohort treated with GPT was 18.7 months. The 1- and 2-year overall, local progression-free, and progression-free survival rates were 70.4% and 35.7%, 78.2% and 59.0%, and 38.6% and 20.8%, respectively. Multivariate analysis revealed that LAPCs at the pancreatic body-tail and those without anterior peripancreatic invasion were independently associated with longer overall survival (P = 0.040 and P = 0.015, respectively). The median overall survival of patients with LAPC at the pancreatic body-tail and those with LAPC without anterior peripancreatic invasion were 24.1 and 28.1 months, respectively. LAPCs at the pancreatic body-tail had a higher volume ratio irradiated over 60 Gy equivalents at gross tumor volume than those at the pancreatic head (P < 0.001). LAPCs with anterior peripancreatic invasion had more peritoneal recurrence within 6 months after GTP than those without anterior peripancreatic invasion (P = 0.039).ConclusionsGPT is a promising treatment option for patients with LAPC at the pancreatic body-tail and those with LAPC without anterior peripancreatic invasion.
Highlights
Factors associated with long-term survival in gemcitabine-concurrent proton radiotherapy (GPT) for non-metastatic, locally advanced pancreatic cancer (LAPC) remain unclear
This study identified its long-term outcomes in a large number of patients with LAPC treated with GPT and assessed the factors associated with long-term survival outcomes of GPT for LAPC
The median gross tumor volume (GTV) volume and the volume ratio irradiated over 60 Gy equivalents (GyE) (V60GyE) at the GTV were 44.0 cc (7.9–141.0) and 59.4% (6.2–99.7), respectively
Summary
Factors associated with long-term survival in gemcitabine-concurrent proton radiotherapy (GPT) for non-metastatic, locally advanced pancreatic cancer (LAPC) remain unclear. The standard treatment for LAPC is chemotherapy or chemoradiotherapy [4], and recent studies have shown that intensive chemotherapies, such as multiagent 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) and gemcitabine plus nab-paclitaxel (GnP), achieved long-term overall survival (OS) [5, 6]. Other studies have reported that the combination of radiotherapy with chemotherapy improves local control and prolongs OS compared with chemotherapy alone [7, 8]. Some studies have reported encouraging results of PRT for LAPC, including increased irradiation doses, improved local control, and prolonged OS [14,15,16,17,18]. Patient backgrounds and treatment protocols varied among these studies; it remains unclear which group of patients can achieve feasible outcomes with PRT
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