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KMID : 0859320090270030145
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Journal of the Korean Society for Therapeutic Radiology and Oncology
2009 Volume.27 No. 3 p.145 ~ p.152
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The Results of Radiotherapy in Locally Advanced, Unresectable Pancreatic Cancer
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Jang Hyun-Soo
Kang Seung-Hee
Kim Sang-Won
Chun Mi-Son
Cho Sun-Mi
Lim Jun-Chul
Oh Young-Taek
Kang Seok-Yun
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Abstract
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Purpose: We retrospectively studied the outcomes and prognostic factors of patients with locally advanced, unresectable pancreatic cancer who were treated with concurrent chemoradiotherapy (CCRT) or radiotherapy only.
Materials and Methods : Fifty-one patients with locally advanced, unresectable pancreatic cancer (stage IIA~III) who recevied radiotherapy (≥30 Gy) between January 1994 and August 2008 were reviewed retrospectively. The median radiation dose was 39 Gy. Chemotherapy consisted of gemcitabine, cisplatin, or 5-FU alone or in various combinations, and was administered concurrently with radiotherapy in 38 patients.
Results: The follow-up period ranged from 2~40 months (median, 8 months). The median survival, and the 1- and 2-year overall survival (OS) rates were 7 months, 15.7%, and 5.9%, respectively. Based on univariate analysis, the baseline CA19-9, performance status, and chemotherapy regimen were significant prognostic factors. The median survival was 8 months for CCRT, and 6 months for radiotherapy alone. The patients treated with gemcitabine-containing regimens had longer survival (median, 10 months) than the patients treated with radiotherapy alone (p=0.027). Twenty-three patients were available to evaluate the patterns of failure. Distant metastases (DM) occured in 18 patients and regional recurrences were demonstrated in 4 patients. Local progression developed in 14 patients. We analyzed the association between the time-to-DM and the baseline CA19-9 levels for 18 evaluable patients. The median time-to-DM was 20 months for patients with normal baseline CA19-9 levels and 2 months for patients with baseline CA19-9 levels ≥200 U/ml.
Conclusion: CCRT with gemcitabine-based regimens was effective in improving OS in patients with locally advanced, unresectable pancreatic cancer. We suggest that the baseline CA19-9 level is valuable in determining the treatment strategy for patients with locally advanced, unresectable pancreatic cancer.
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KEYWORD
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Pancreatic cancer, Concurrent chemoradiotherapy, Radiotherapy, CA19-9
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