PURPOSE: To evaluate the outcomes of chemoradiotherapy (CRT) after neoadjuvant chemotherapy consisting of gemcitabine and erlotinib for unresectable locally advanced pancreatic cancer. METHODS: Between 2010 and 2014, 24 patients with unresectable pancreatic cancer received neoadjuvant gemcitabine/erlotinib followed by CRT. There were 9 men and 15 women, and median age was 61 years (range 48-77). Radiotherapy (RT) was delivered to the tumor and regional lymph nodes with a median dose of 50.4 Gy (range 50.4-56). All patients received concurrent chemotherapy, with 5-fluorouracil (5-FU), capecitabine or gemcitabine and 17 patients received maintenance chemotherapy with gemcitabine plus erlotinib, 5-FU plus leukovorin or capecitabine plus oxaliplatin. The median follow-up period was 17 months (range 7-31). RESULTS: The median overall survival (OS) and post-RT OS (PROS) were 17.8 and 10.7 months, respectively. On multivariate analysis, RT dose (p=0.005) and maintenance chemotherapy (p=0.019) were significant prognostic factors for OS. In addition, RT dose ≥54Gy (p=0.021) and concurrent gemcitabine (p=0.012) were identified as favorable prognostic factors for PROS. Grade 3 hematologic and gastrointestinal toxicities occurred in 3 and 2 patients, respectively. CONCLUSIONS: Intensive treatment with gemcitabine-based CRT, high RT dose, and maintenance chemotherapy may improve survival outcomes in locally advanced pancreatic cancer patients receiving neoadjuvant gemcitabine/erlotinib.
PURPOSE: To evaluate the outcomes of chemoradiotherapy (CRT) after neoadjuvant chemotherapy consisting of gemcitabine and erlotinib for unresectable locally advanced pancreatic cancer. METHODS: Between 2010 and 2014, 24 patients with unresectable pancreatic cancer received neoadjuvant gemcitabine/erlotinib followed by CRT. There were 9 men and 15 women, and median age was 61 years (range 48-77). Radiotherapy (RT) was delivered to the tumor and regional lymph nodes with a median dose of 50.4 Gy (range 50.4-56). All patients received concurrent chemotherapy, with 5-fluorouracil (5-FU), capecitabine or gemcitabine and 17 patients received maintenance chemotherapy with gemcitabine plus erlotinib, 5-FU plus leukovorin or capecitabine plus oxaliplatin. The median follow-up period was 17 months (range 7-31). RESULTS: The median overall survival (OS) and post-RT OS (PROS) were 17.8 and 10.7 months, respectively. On multivariate analysis, RT dose (p=0.005) and maintenance chemotherapy (p=0.019) were significant prognostic factors for OS. In addition, RT dose ≥54Gy (p=0.021) and concurrent gemcitabine (p=0.012) were identified as favorable prognostic factors for PROS. Grade 3 hematologic and gastrointestinal toxicities occurred in 3 and 2 patients, respectively. CONCLUSIONS: Intensive treatment with gemcitabine-based CRT, high RT dose, and maintenance chemotherapy may improve survival outcomes in locally advanced pancreatic cancerpatients receiving neoadjuvant gemcitabine/erlotinib.