Abstract
BackgroundTo evaluate the role of intensity modulated radiotherapy (IMRT) for locally advanced pancreatic cancer (LAPC) and metastatic pancreatic cancer (MPC), and the prognostic factors in the setting of multidisciplinary approach strategies.Methods63 patients with LAPC and MPC receiving IMRT in our institution were retrospectively identified. Information on patient baseline, treatment characteristics and overall survival (OS) time were collected. Data of pain relief and toxicity were evaluated. Univariate and multivariate analyses were conducted to investigate the prognostic factors.ResultsAll patients received IMRT with a median dose of 46.0 Gy. The median OS for LAPC and MPC patients were 15.7 months and 8.0 months, respectively (p = 0.029). Symptomatic improvements were observed in the 44 patients with abdominal/back pain after radiotherapy (RT) or concurrent chemoradiotherapy (CCRT), particularly in those with severe pain. Only 13.9% and 14.8% cases presented Grade ≥ 3 hematologic toxicities in RT and CCRT group, while no cases developed Grade ≥ 3 non-hematologic toxicities in both groups. Multivariate analysis indicated that tumors located in pancreas body/tail (HR 0.28, p = 0.008), pretreatment CA19-9 < 1000 U/mL (HR 0.36, p = 0.029) and concurrent chemotherapy (HR 0.37, p = 0.016) were independent favorable predictors for OS.ConclusionsCCRT further improved OS for LAPC and MPC with acceptable toxicities, and use of RT markedly alleviated pain. Tumors located in pancreas body/tail, pretreatment CA19-9 level of < 1000 U/mL and CCRT were associated with better OS. However, regional intra-arterial chemotherapy did not show any survival benefit in our study.
Highlights
To evaluate the role of intensity modulated radiotherapy (IMRT) for locally advanced pancreatic cancer (LAPC) and metastatic pancreatic cancer (MPC), and the prognostic factors in the setting of multidisciplinary approach strategies
Given that micrometastatic distant disease is most likely in LAPC patients, several months of induction chemotherapy have been proposed in order to exclude those, whose subclinical distant metastases become clinical during the induction chemotherapy and to pick up those appropriate patients, who would probably benefit from chemoradiotherapy
Multivariate analysis indicated that tumors located in pancreas body/tail (HR 0.28, 95% CI 0.11 – 0.71, p = 0.008; Figure 2A), pretreatment CA19-9 < 1000 U/mL (HR 0.36, 95% CI 0.14 – 0.90, p = 0.029; Figure 2B) and concurrent chemotherapy (HR 0.37, 95% CI 0.16 – 0.83, p = 0.016; Figure 2C) were the independent favorable predictors for overall survival (OS) (Table 5)
Summary
To evaluate the role of intensity modulated radiotherapy (IMRT) for locally advanced pancreatic cancer (LAPC) and metastatic pancreatic cancer (MPC), and the prognostic factors in the setting of multidisciplinary approach strategies. At the time of diagnosis, about 30% of patients present as locally advanced pancreatic cancer (LAPC), with a poor median survival of 10–12 months [3]. A randomized phase III study showed that CCRT offered survival benefit when. In a phase III randomized trial (ECOG-4201) to compare CCRT with chemotherapy alone in LAPC, which was closed early due to the poor accrual, for 74 patients enrolled in this study the median overall survival (OS) was significantly longer in the CCRT arm than that in chemotherapy alone [8]. After several cycles of induction chemotherapy, CCRT will be delivered to the patients showing no evidence of disease progression This approach could theoretically avoid unnecessary RT to the patients with subclinically distant metastases. RT would play an important role in pain relief for patients suffering from severe pain, even for metastatic pancreatic cancer (MPC)
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