Florence Huguet1,2, Carla Hajj2, Corrine B Winston3, Weiji Shi4, Zhigang Zhang4, Abraham J Wu2, Eileen M O'Reilly5, Diane L Reidy5, Peter Allen6, Karyn A Goodman7. 1. a Department of Radiation Oncology , Tenon Hospital, Hôpitaux Universitaires Est Parisien, University Pierre and Marie Curie Paris VI , Paris , France. 2. b Department of Radiation Oncology at Memorial Sloan-Kettering Cancer Center , New York , NY , USA. 3. c Department of Radiology at Memorial Sloan-Kettering Cancer Center , New York , NY , USA. 4. d Department of Biostatistics at Memorial Sloan-Kettering Cancer Center , New York , NY , USA. 5. e Department of Medical Oncology at Memorial Sloan-Kettering Cancer Center , New York , NY , USA. 6. f Department of Surgery at Memorial Sloan-Kettering Cancer Center , New York , NY , USA. 7. g Department of Radiation Oncology , University of Colorado School of Medicine , Aurora , CO , USA.
Abstract
BACKGROUND: To assess local control, survival and conversion to resectability among locally advanced pancreatic cancer (LAPC) patients treated with induction chemotherapy (ICT) followed by chemoradiotherapy treatment using intensity-modulated radiation therapy (IMRT). MATERIAL AND METHODS: Between 2007 and 2012, 134 LAPC patients were treated with ICT followed by IMRT. After chemoradiotherapy, 40 patients received maintenance chemotherapy. RESULTS: With a median follow-up of 20 months, median overall survival (OS) was 23 months. One- and two-year OS was 85% and 47%, respectively. On multivariate analysis, progression of disease after IMRT was associated with worse OS. Cumulative incidence of local failure was 10% at one year and 36% at two years. Twenty-six patients (19%) underwent resection after chemoradiotherapy including 22 patients (85%) with negative margins. On multivariate analysis, response to IMRT was associated with surgery (p = .01). Acute grade 3-4 hematologic and non-hematologic toxicity rates were 26% and 4.5%, respectively. CONCLUSION: IMRT is safe in patients with LAPC. Patients with non-progressive LAPC after ICT and who received IMRT had high rates of local control and prolonged survival.
BACKGROUND: To assess local control, survival and conversion to resectability among locally advanced pancreatic cancer (LAPC) patients treated with induction chemotherapy (ICT) followed by chemoradiotherapy treatment using intensity-modulated radiation therapy (IMRT). MATERIAL AND METHODS: Between 2007 and 2012, 134 LAPC patients were treated with ICT followed by IMRT. After chemoradiotherapy, 40 patients received maintenance chemotherapy. RESULTS: With a median follow-up of 20 months, median overall survival (OS) was 23 months. One- and two-year OS was 85% and 47%, respectively. On multivariate analysis, progression of disease after IMRT was associated with worse OS. Cumulative incidence of local failure was 10% at one year and 36% at two years. Twenty-six patients (19%) underwent resection after chemoradiotherapy including 22 patients (85%) with negative margins. On multivariate analysis, response to IMRT was associated with surgery (p = .01). Acute grade 3-4 hematologic and non-hematologic toxicity rates were 26% and 4.5%, respectively. CONCLUSION: IMRT is safe in patients with LAPC. Patients with non-progressive LAPC after ICT and who received IMRT had high rates of local control and prolonged survival.
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