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. 2018 Jul;194(7):627-637.
doi: 10.1007/s00066-018-1281-7. Epub 2018 Mar 1.

Nonmetastatic Pancreatic Cancer : Improved Survival With Chemoradiotherapy > 40 Gy After Systemic Treatment

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Free PMC article

Nonmetastatic Pancreatic Cancer : Improved Survival With Chemoradiotherapy > 40 Gy After Systemic Treatment

Sebastian Bachmayer et al. Strahlenther Onkol. .
Free PMC article

Abstract

Purpose: The role of radiotherapy (RT) for nonmetastatic pancreatic cancer is still a matter of debate since randomized control trials have shown inconsistent results. The current retrospective single-institution study includes both resected and unresected patients with nonmetastasized pancreatic cancer. The aim is to analyze overall survival (OS) after irradiation combined with induction chemotherapy.

Patients and methods: Of the 73 patients with nonmetastatic pancreatic cancer eligible for the present analysis, 42 (58%) patients had adjuvant chemoradiotherapy (CRT), while 31 (42%) received CRT as primary treatment. In all, 65 (89%) had chemotherapy at any time before, during, or after RT, and 39 (53%) received concomitant CRT. The median total dose was 50 Gy (range 12-77 Gy), while 61 (84%) patients received >40 Gy.

Results: With a median follow-up of 22 months (range 1.2-179.8 months), 14 (19%) are still alive and 59 (81%) of the patients have died, whereby 51 (70%) were cancer-related deaths. Median OS and the 2‑year survival rate were 22.9 months (1.2-179.8 months) and 44%, respectively. In addition, 61 (84%) patients treated with >40 Gy had a survival advantage (median OS 23.7 vs. 17.3 months, p = 0.026), as had patients with 4 months minimum of systemic treatment (median OS 27.5 vs. 14.3 months, p = 0.0004).

Conclusion: CRT with total doses >40 Gy after induction chemotherapy leads to improved OS in patients with nonmetastatic pancreatic cancer.

Hintergrund: Die Bedeutung der Radiotherapie (RT) in der Behandlung des nichtmetastasierten Pankreaskarzinoms ist nach wie vor umstritten, zumal die Ergebnisse randomisierter Studien inkonklusiv sind. Die vorliegende retrospektive Studie inkludiert sowohl operierte als auch nichtoperierte Patienten mit nichtmetastasiertem Pankreaskarzinom. Primärer Endpunkt der Analyse ist das Gesamtüberleben (OS) nach Bestrahlung und vorangegangener Induktionschemotherapie.

Patienten und Methoden: Analysiert wurden 73 Patienten mit nichtmetastasiertem Pankreaskarzinom. Von diesen hatten 42 (58 %) eine adjuvante Chemoradiotherapie (CRT). Eine CRT als primäre Behandlung erhielten 31 (42 %) nichtoperierte Patienten. Eine Chemotherapie vor, während oder nach RT hatten 65 (89 %), 39 (53 %) bekamen eine konkomittante CRT. Die mediane Gesamtdosis war 50 Gy (Spanne 12–77 Gy). Mehr als 40 Gy erhielten 61 Patienten (84 %).

Ergebnisse: Bei einer medianen Nachsorgedauer von 22 Monaten (Spanne 1,2–179,8 Monate) waren 59 (81 %) Patienten verstorben, 14 (19 %) leben noch. Die Todesursache war bei 51 (70 %) Patienten ihre Tumorerkrankung. Das mediane Überleben betrug 22,9 Monate (Spanne 1,2–179,8 Monate), das 2‑Jahres-Überleben 44 %. Insgesamt 61 (84 %) Patienten, die mit >40 Gy behandelt wurden, hatten einen Überlebensvorteil (medianes OS 23,7 vs. 17,3 Monate; p = 0,026), ebenso Patienten nach mindestens 4 Monaten Systemtherapie (medianes OS 27,5 vs. 14,3 Monate; p = 0,0004).

Schlussfolgerung: Eine CRT mit Gesamtdosen >40 Gy nach Induktionschemotherapie verbessert das OS bei Patienten mit nichtmetastasiertem Pankreaskarzinom.

Keywords: Adjuvant chemotherapy; Overall survival; Pancreatic cancer; Retrospective analysis; Surgery.

Conflict of interest statement

Conflict of interest

S. Bachmayer, G. Fastner, A. Vaszi, W. Iglseder, P. Kopp, J. Holzinger, A. Dinnewitzer, G. Rinnerthaler, S.P. Gampenrieder, K. Emmanuel, R. Greil, F. Sedlmayer and F. Zehentmayr declare that they have no competing interests.

Ethical standards

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Overall survival in 73 patients with nonmetastatic pancreatic cancer
Fig. 2
Fig. 2
Overall survival is significantly improved in 61 patients with radiotherapy doses >40 Gy compared to the 12 patients who received <40 Gy (log-rank p = 0.027)
Fig. 3
Fig. 3
Comparison of patients by duration of induction chemotherapy: overall survival is significantly better in 44 patients with >4 months than in 29 patients with <4 months (log-rank p = 0.0004)
Fig. 4
Fig. 4
Comparison by combined treatment modalities: overall survival is significantly better in 53 patients who received >4 months of chemotherapy followed by >40 Gy than in the other 20 patients who had <4 months of chemotherapy and/or <40 Gy (log-rank p = 0.0002)

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