Chemotherapy and intensity-modulated radiation therapy for locally advanced pancreatic cancer achieves a high rate of R0 resection*

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d15087750e208">Background</h5> <p id="P1">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). </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d15087750e213">Material and Methods</h5> <p id="P2">Between 2007 and 2012, 134 LAPC patients were treated with ICT followed by IMRT. After chemoradiotherapy, 40 patients received maintenance chemotherapy. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d15087750e218">Results</h5> <p id="P3">With a median follow-up of 20 months, median overall survival (OS) was 23 months. One-year and 2-year OS was 85% and 47%, respectively. On multivariate analysis, progression of disease after IMRT was associated with worse overall survival. Cumulative incidence of local failure was 10% at 1 year and 36% at 2 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=0.01). Acute grade 3–4 hematologic and non-hematologic toxicity rates were 26% and 4.5%, respectively. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d15087750e223">Conclusion</h5> <p id="P4">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. </p> </div>