Concurrent Radiotherapy and Gemcitabine for Unresectable Pancreatic Adenocarcinoma: Impact of Adjuvant Chemotherapy on Survival
- Department of Radiology, University of the Ryukyus, Okinawa (Japan)
- Department of Radiation Oncology, National Cancer Center, Tokyo (Japan)
- Department of Radiology, Sapporo Medical University, Sapporo (Japan)
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University, Kyoto (Japan)
- Department of Radiation Oncology, Institute of Biomedical Research and Innovation Hospital, Kobe (Japan)
- Department of Radiation Oncology, Kurume University, Kurume (Japan)
- Department of Radiology, Tokyo Medical and Dental University, Tokyo (Japan)
- Department of Radiation Oncology, Nihon University Itabashi Hospital, Tokyo (Japan)
- Department of Radiology, Yamanashi University, Yamanashi (Japan)
- Department of Radiation Oncology, Tokyo Metropolitan Komagome Hospital, Tokyo (Japan)
- Department of Radiation Oncology, Yamagata University, Yamagata (Japan)
- Department of Radiation Oncology, Kinki University School of Medicine, Osaka (Japan)
Purpose: To retrospectively analyze results of concurrent chemoradiotherapy (CCRT) using gemcitabine (GEM) for unresectable pancreatic adenocarcinoma. Methods and Materials: Records of 108 patients treated with concurrent external beam radiotherapy (EBRT) and GEM were reviewed. The median dose of EBRT in all 108 patients was 50.4 Gy (range, 3.6-60.8 Gy), usually administered in conventional fractionations (1.8-2 Gy/day). During radiotherapy, most patients received GEM at a dosage of 250 to 350 mg/m{sup 2} intravenously weekly for approximately 6 weeks. After CCRT, 59 patients (54.6%) were treated with adjuvant chemotherapy (AC), mainly with GEM. The median follow-up for all 108 patients was 11.0 months (range, 0.4-37.9 months). Results: Initial responses after CCRT for 85 patients were partial response: 26 patients, no change: 51 patients and progressive disease: 8 patients. Local progression was observed in 35 patients (32.4%), and the 2-year local control (LC) rate in all patients was 41.9%. Patients treated with total doses of 50 Gy or more had significantly more favorable LC rates (2-year LC rate, 42.9%) than patients treated with total doses of less than 50 Gy (2-year LC rate, 29.6%). Regional lymph node recurrence was found in only 1 patient, and none of the 57 patients with clinical N0 disease had regional lymph node recurrence. The 2-year overall survival (OS) rate and the median survival time in all patients were 23.5% and 11.6 months, respectively. Patients treated with AC had significantly more favorable OS rates (2-year OS, 31.8%) than those treated without AC (2-year OS, 12.4%; p < 0.0001). On multivariate analysis, AC use and clinical T stage were significant prognostic factors for OS. Conclusions: CCRT using GEM yields a relatively favorable LC rate for unresectable pancreatic adenocarcinoma, and CCRT with AC conferred a survival benefit compared to CCRT without AC.
- OSTI ID:
- 22056385
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 83, Issue 2; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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