Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지
DOI QR코드

DOI QR Code

Definitive concurrent chemoradiotherapy in locally advanced pancreatic cancer

  • Kwak, Yoo-Kang (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Jong Hoon (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Myung-Ah (Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Chun, Hoo-Geun (Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kim, Dong-Goo (Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • You, Young Kyoung (Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Hong, Tae-Ho (Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Jang, Hong Seok (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine)
  • Received : 2014.03.31
  • Accepted : 2014.05.21
  • Published : 2014.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Survival outcome of locally advanced pancreatic cancer has been poor and little is known about prognostic factors of the disease, especially in locally advanced cases treated with concurrent chemoradiation. This study was to analyze overall survival and prognostic factors of patients treated with concurrent chemoradiotherapy (CCRT) in locally advanced pancreatic cancer. Materials and Methods: Medical records of 34 patients diagnosed with unresectable pancreatic cancer and treated with definitive CCRT, from December 2003 to December 2012, were reviewed. Median prescribed radiation dose was 50.4 Gy (range, 41.4 to 55.8 Gy), once daily, five times per week, 1.8 to 3 Gy per fraction. Results: With a mean follow-up of 10 months (range, 0 to 49 months), median overall survival was 9 months. The 1- and 2-year survival rates were 40% and 10%, respectively. Median and mean time to progression were 5 and 7 months, respectively. Prognostic parameters related to overall survival were post-CCRT CA19-9 (p = 0.02), the Eastern Cooperative Oncology Group (ECOG) status (p < 0.01), and radiation dose (p = 0.04) according to univariate analysis. In multivariate analysis, post-CCRT CA19-9 value below 180 U/mL and ECOG status 0 or 1 were statistically significant independent prognostic factors associated with improved overall survival (p < 0.01 and p = 0.02, respectively). Conclusion: Overall treatment results in locally advanced pancreatic cancer are relatively poor and few improvements have been accomplished in the past decades. Post-treatment CA19-9 below 180 U/mL and ECOG performance status 0 and 1 were significantly associated with an improved overall survival.

Keywords

References

  1. Royal RE, Wolff RA, Crane CH. Cancer of pancreas. In: DeVita VT, Lawrence TS, Rosenberg SA, editors. DeVita, Hellman, and Rosenberg's cancer: principles & practice of oncology. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2011. p. 961-89.
  2. Park JK, Yoon YB, Kim YT, et al. Survival and prognostic factors of unresectable pancreatic cancer. J Clin Gastroenterol 2008; 42:86-91. https://doi.org/10.1097/01.mcg.0000225657.30803.9d
  3. Moertel CG, Frytak S, Hahn RG, et al. Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil: The Gastrointestinal Tumor Study Group. Cancer 1981;48:1705-10. https://doi.org/10.1002/1097-0142(19811015)48:8<1705::AID-CNCR2820480803>3.0.CO;2-4
  4. Gastrointestinal Tumor Study Group. Treatment of locally unresectable carcinoma of the pancreas: comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone. J Natl Cancer Inst 1988;80:751-5. https://doi.org/10.1093/jnci/80.10.751
  5. Gastrointestinal Tumor Study Group. A multi-institutional comparative trial of radiation therapy alone and in combination with 5-fluorouracil for locally unresectable pancreatic carcinoma. Ann Surg 1979;189:205-8.
  6. Kornek GV, Schratter-Sehn A, Marczell A, et al. Treatment of unresectable, locally advanced pancreatic adenocarcinoma with combined radiochemotherapy with 5-fluorouracil, leucovorin and cisplatin. Br J Cancer 2000;82:98-103. https://doi.org/10.1054/bjoc.1999.0884
  7. Safran H, King TP, Choy H, et al. Paclitaxel and concurrent radiation for locally advanced pancreatic and gastric cancer: a phase I study. J Clin Oncol 1997;15:901-7. https://doi.org/10.1200/JCO.1997.15.3.901
  8. Hawes RH, Xiong Q, Waxman I, Chang KJ, Evans DB, Abbruzzese JL. A multispecialty approach to the diagnosis and management of pancreatic cancer. Am J Gastroenterol 2000; 95:17-31. https://doi.org/10.1111/j.1572-0241.2000.01699.x
  9. Gorovets D, Saif MW, Huber K. Novel treatment approaches for locally advanced pancreatic cancer. JOP 2014;15:95-8.
  10. Kim HS, Yi SY, Jun HJ, et al. Definitive chemoradiation therapy with capecitabine in locally advanced pancreatic cancer. Anticancer Drugs 2010;21:107-12. https://doi.org/10.1097/CAD.0b013e328332a7fc
  11. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45:228-47. https://doi.org/10.1016/j.ejca.2008.10.026
  12. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995;31:1341-6. https://doi.org/10.1016/0360-3016(95)00060-C
  13. Cardenes HR, Chiorean EG, Dewitt J, Schmidt M, Loehrer P. Locally advanced pancreatic cancer: current therapeutic approach. Oncologist 2006;11:612-23. https://doi.org/10.1634/theoncologist.11-6-612
  14. Earle CC, Agboola O, Maroun J, Zuraw L; Cancer Care Ontario Practice Guidelines Initiative's Gastrointestinal Cancer Disease Site Group. The treatment of locally advanced pancreatic cancer: a practice guideline. Can J Gastroenterol 2003;17:161-7. https://doi.org/10.1155/2003/410276
  15. Chang JS, Wang ML, Koom WS, et al. High-dose helical tomotherapy with concurrent full-dose chemotherapy for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2012;83:1448-54. https://doi.org/10.1016/j.ijrobp.2011.10.050
  16. Murphy JD, Adusumilli S, Griffith KA, et al. Full-dose gemcitabine and concurrent radiotherapy for unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 2007;68:801-8. https://doi.org/10.1016/j.ijrobp.2006.12.053
  17. Golden DW, Novak CJ, Minsky BD, Liauw SL. Radiation dose ${\geq}$54 Gy and CA 19-9 response are associated with improved survival for unresectable, non-metastatic pancreatic cancer treated with chemoradiation. Radiat Oncol 2012;7:156. https://doi.org/10.1186/1748-717X-7-156
  18. Tozzi A, Comito T, Alongi F, et al. SBRT in unresectable advanced pancreatic cancer: preliminary results of a monoinstitutional experience. Radiat Oncol 2013;8:148. https://doi.org/10.1186/1748-717X-8-148
  19. Trakul N, Koong AC, Chang DT. Stereotactic body radiotherapy in the treatment of pancreatic cancer. Semin Radiat Oncol 2014;24:140-7. https://doi.org/10.1016/j.semradonc.2013.11.008
  20. Terashima K, Demizu Y, Hashimoto N, et al. A phase I/II study of gemcitabine-concurrent proton radiotherapy for locally advanced pancreatic cancer without distant metastasis. Radiother Oncol 2012;103:25-31. https://doi.org/10.1016/j.radonc.2011.12.029
  21. Barhoumi M, Mornex F, Bonnetain F, et al. Locally advanced unresectable pancreatic cancer: Induction chemoradiotherapy followed by maintenance gemcitabine versus gemcitabine alone: definitive results of the 2000-2001 FFCD/SFRO phase III trial. Cancer Radiother 2011;15:182-91. https://doi.org/10.1016/j.canrad.2010.10.001
  22. Crane CH, Abbruzzese JL, Evans DB, et al. Is the therapeutic index better with gemcitabine-based chemoradiation than with 5-fluorouracil-based chemoradiation in locally advanced pancreatic cancer? Int J Radiat Oncol Biol Phys 2002;52:1293-302. https://doi.org/10.1016/S0360-3016(01)02740-7
  23. Huang PI, Chao Y, Li CP, et al. Efficacy and factors affecting outcome of gemcitabine concurrent chemoradiotherapy in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2009;73:159-65. https://doi.org/10.1016/j.ijrobp.2008.04.012
  24. Li CP, Chao Y, Chi KH, et al. Concurrent chemoradiotherapy treatment of locally advanced pancreatic cancer: gemcitabine versus 5-fluorouracil, a randomized controlled study. Int J Radiat Oncol Biol Phys 2003;57:98-104. https://doi.org/10.1016/S0360-3016(03)00435-8
  25. Ogawa K, Ito Y, Hirokawa N, et al. Concurrent radiotherapy and gemcitabine for unresectable pancreatic adenocarcinoma: impact of adjuvant chemotherapy on survival. Int J Radiat Oncol Biol Phys 2012;83:559-65. https://doi.org/10.1016/j.ijrobp.2011.07.013
  26. Abrams RA, Grochow LB, Chakravarthy A, et al. Intensified adjuvant therapy for pancreatic and periampullary adenocarcinoma: survival results and observations regarding patterns of failure, radiotherapy dose and CA19-9 levels. Int J Radiat Oncol Biol Phys 1999;44:1039-46. https://doi.org/10.1016/S0360-3016(99)00107-8
  27. Heinemann V, Schermuly MM, Stieber P, et al. CA19-9: a pedictor of response in pancreatic cancer treated with gemcitabine and cisplatin. Anticancer Res 1999;19:2433-5.
  28. Ishii H, Okada S, Tokuuye K, et al. Protracted 5-fluorouracil infusion with concurrent radiotherapy as a treatment for locally advanced pancreatic carcinoma. Cancer 1997;79:1516-20. https://doi.org/10.1002/(SICI)1097-0142(19970415)79:8<1516::AID-CNCR11>3.0.CO;2-0
  29. Yoo T, Lee WJ, Woo SM, et al. Pretreatment carbohydrate antigen 19-9 level indicates tumor response, early distant metastasis, overall survival, and therapeutic selection in localized and unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 2011;81:e623-30. https://doi.org/10.1016/j.ijrobp.2011.02.063
  30. Micke O, Bruns F, Kurowski R, et al. Predictive value of carbohydrate antigen 19-9 in pancreatic cancer treated with radiochemotherapy. Int J Radiat Oncol Biol Phys 2003;57:90-7. https://doi.org/10.1016/S0360-3016(03)00524-8
  31. Montgomery RC, Hoffman JP, Riley LB, Rogatko A, Ridge JA, Eisenberg BL. Prediction of recurrence and survival by postresection CA 19-9 values in patients with adenocarcinoma of the pancreas. Ann Surg Oncol 1997;4:551-6. https://doi.org/10.1007/BF02305535
  32. Magnani JL, Steplewski Z, Koprowski H, Ginsburg V. Identification of the gastrointestinal and pancreatic cancerassociated antigen detected by monoclonal antibody 19-9 in the sera of patients as a mucin. Cancer Res 1983;43:5489-92.

Cited by

  1. Antineoplastics : Grade 3 abdominal pain and thrombocytopenia with neutropenia: case report vol.1520, pp.1, 2014, https://doi.org/10.1007/s40278-014-3612-5
  2. Modeling Combined Chemotherapy and Particle Therapy for Locally Advanced Pancreatic Cancer vol.5, pp.None, 2014, https://doi.org/10.3389/fonc.2015.00145
  3. Can Nigella Sativa and Pure Honey Improved Chemoradiotherapy Effects in Advanced Pancreatic Cancer vol.7, pp.3, 2017, https://doi.org/10.15406/jnhfe.2017.07.00242