OBJECTIVES: At diagnosis, 30% of patients with pancreatic cancer are unresectable stage 3 locally advanced. The standard treatment for locally advanced pancreatic cancer (LAPC) is not defined. The current study was conducted to assess the roles of chemotherapy and chemoradiation for LAPC treatment. MATERIALS AND METHODS: Between June 2006 and March 2011, 100 patients with LAPC were treated at the Johns Hopkins Hospital. Retrospective analysis was performed to compare cumulative incidence of progression (CIP) and overall survival (OS) among different subgroups. RESULTS: For the 100 patients, the median OS was 15.8 months and the median CIP was 8.4 months. The combination of chemotherapy and chemoradiation before disease progression was significantly associated with improved CIP (P=0.001) and improved OS when compared with chemoradiation alone (median OS: 16.4 vs. 11.1 mo, P=0.03). Among patients receiving combination treatment, patients who received chemotherapy first followed by chemoradiation had a trend toward lower CIP (P=0.09) and improved OS (median OS: 18.1 vs. 11.0 mo, P=0.09). Patients who received >2 cycles of chemotherapy before chemoradiation had a significantly decreased CIP (P=0.008) and a trend toward better OS (median OS: 19.4 vs. 15.7 mo, P=0.10). On multivariate analysis, receiving >2 cycles of chemotherapy before chemoradiation was associated with improved CIP. CONCLUSIONS: Although combination chemotherapy and chemoradiation is favored in the treatment of LAPC, longer induction chemotherapy may play a more important role in sensitization of tumors to subsequent chemoradiation. Our results support treating patients with induction chemotherapy for at least 3 cycles followed by consolidative chemoradiation. These results merit further validation by a prospective study.
OBJECTIVES: At diagnosis, 30% of patients with pancreatic cancer are unresectable stage 3 locally advanced. The standard treatment for locally advanced pancreatic cancer (LAPC) is not defined. The current study was conducted to assess the roles of chemotherapy and chemoradiation for LAPC treatment. MATERIALS AND METHODS: Between June 2006 and March 2011, 100 patients with LAPC were treated at the Johns Hopkins Hospital. Retrospective analysis was performed to compare cumulative incidence of progression (CIP) and overall survival (OS) among different subgroups. RESULTS: For the 100 patients, the median OS was 15.8 months and the median CIP was 8.4 months. The combination of chemotherapy and chemoradiation before disease progression was significantly associated with improved CIP (P=0.001) and improved OS when compared with chemoradiation alone (median OS: 16.4 vs. 11.1 mo, P=0.03). Among patients receiving combination treatment, patients who received chemotherapy first followed by chemoradiation had a trend toward lower CIP (P=0.09) and improved OS (median OS: 18.1 vs. 11.0 mo, P=0.09). Patients who received >2 cycles of chemotherapy before chemoradiation had a significantly decreased CIP (P=0.008) and a trend toward better OS (median OS: 19.4 vs. 15.7 mo, P=0.10). On multivariate analysis, receiving >2 cycles of chemotherapy before chemoradiation was associated with improved CIP. CONCLUSIONS: Although combination chemotherapy and chemoradiation is favored in the treatment of LAPC, longer induction chemotherapy may play a more important role in sensitization of tumors to subsequent chemoradiation. Our results support treating patients with induction chemotherapy for at least 3 cycles followed by consolidative chemoradiation. These results merit further validation by a prospective study.
Authors: Mark P Callery; Kenneth J Chang; Elliot K Fishman; Mark S Talamonti; L William Traverso; David C Linehan Journal: Ann Surg Oncol Date: 2009-04-24 Impact factor: 5.344
Authors: Daniel D Von Hoff; Ramesh K Ramanathan; Mitesh J Borad; Daniel A Laheru; Lon S Smith; Tina E Wood; Ronald L Korn; Neil Desai; Vuong Trieu; Jose L Iglesias; Hui Zhang; Patrick Soon-Shiong; Tao Shi; N V Rajeshkumar; Anirban Maitra; Manuel Hidalgo Journal: J Clin Oncol Date: 2011-10-03 Impact factor: 44.544
Authors: Girish Mishra; Jerome Butler; Coty Ho; Susan Melin; L Douglas Case; Peter R Ennever; Gustav C Magrinat; James D Bearden; Drew C Minotto; Russell Howerton; Edward Levine; A William Blackstock Journal: Am J Clin Oncol Date: 2005-08 Impact factor: 2.339
Authors: Sonali Rudra; Amol K Narang; Timothy M Pawlik; Hao Wang; Elizabeth M Jaffee; Lei Zheng; Dung T Le; David Cosgrove; Ralph H Hruban; Elliot K Fishman; Richard Tuli; Daniel A Laheru; Christopher L Wolfgang; Luis A Diaz; Joseph M Herman Journal: Pract Radiat Oncol Date: 2012
Authors: Malcolm J Moore; David Goldstein; John Hamm; Arie Figer; Joel R Hecht; Steven Gallinger; Heather J Au; Pawel Murawa; David Walde; Robert A Wolff; Daniel Campos; Robert Lim; Keyue Ding; Gary Clark; Theodora Voskoglou-Nomikos; Mieke Ptasynski; Wendy Parulekar Journal: J Clin Oncol Date: 2007-04-23 Impact factor: 44.544
Authors: Sunil Krishnan; Vishal Rana; Nora A Janjan; Gauri R Varadhachary; James L Abbruzzese; Prajnan Das; Marc E Delclos; Morris S Gould; Douglas B Evans; Robert A Wolff; Christopher H Crane Journal: Cancer Date: 2007-07-01 Impact factor: 6.860
Authors: Michael D Chuong; Gregory M Springett; Jessica M Freilich; Catherine K Park; Jill M Weber; Eric A Mellon; Pamela J Hodul; Mokenge P Malafa; Kenneth L Meredith; Sarah E Hoffe; Ravi Shridhar Journal: Int J Radiat Oncol Biol Phys Date: 2013-04-05 Impact factor: 7.038
Authors: Tae Hyun Kim; Woo Jin Lee; Sang Myung Woo; Hyunjung Kim; Eun Sang Oh; Ju Hee Lee; Sung-Sik Han; Sang-Jae Park; Yang-Gun Suh; Sung Ho Moon; Sang Soo Kim; Dae Yong Kim Journal: Technol Cancer Res Treat Date: 2018-01-01
Authors: Eun Sang Oh; Tae Hyun Kim; Sang Myung Woo; Woo Jin Lee; Ju Hee Lee; Sang Hee Youn; Sung Sik Han; Sang Jae Park; Dae Yong Kim Journal: Radiat Oncol J Date: 2018-09-30