Purpose To review outcomes of locally advanced pancreatic cancer (LAPC) patients treated with dose-escalated intensity modulated radiation therapy (IMRT) with curative intent. Methods and Materials A total of 200 patients with LAPC were treated with induction chemotherapy followed by chemoradiation between 2006 and 2014. Of these, 47 (24%) having tumors >1 cm from the luminal organs were selected for dose-escalated IMRT (biologically effective dose [BED] >70 Gy) using a simultaneous integrated boost technique, inspiration breath hold, and computed tomographic image guidance. Fractionation was optimized for coverage of gross tumor and luminal organ sparing. A 2- to 5-mm margin around the gross tumor volume was treated using a simultaneous integrated boost with a microscopic dose. Overall survival (OS), recurrence-free survival (RFS), local-regional and distant RFS, and time to local-regional and distant recurrence, calculated from start of chemoradiation, were the outcomes of interest. Results Median radiation dose was 50.4 Gy (BED = 59.47 Gy) with a concurrent capecitabine-based (86%) regimen. Patients who received BED >70 Gy had a superior OS (17.8 vs 15.0 months, P = .03), which was preserved throughout the follow-up period, with estimated OS rates at 2 years of 36% versus 19% and at 3 years of 31% versus 9% along with improved local-regional RFS (10.2 vs 6.2 months, P = .05) as compared with those receiving BED ≤70 Gy. Degree of gross tumor volume coverage did not seem to affect outcomes. No additional toxicity was observed in the high-dose group. Higher dose (BED) was the only predictor of improved OS on multivariate analysis. Conclusion Radiation dose escalation during consolidative chemoradiation therapy after induction chemotherapy for LAPC patients improves OS and local-regional RFS.

BACKGROUND. The current study was conducted to determine whether there were differences in outcome for patients with unresectable locally advanced pancreatic cancer (LAPC) who received treatment with chemoradiation therapy (CR) versus induction chemotherapy followed by CR (CCR). METHODS. Between December 1993 and July 2005, 323 consecutive patients with LAPC were treated at the authors' institution with radiotherapy and concurrent gemcitabine or fluoropyrimidine chemotherapy. Two hundred forty‐seven patients received CR as initial treatment, and 76 patients received a median of 2.5 months of gemcitabine‐based induction chemotherapy prior to CR. Most patients received a radiation dose of 30 grays in 10 fractions (85%) concurrently with infusional 5‐fluorouracil (41%), gemcitabine (39%), or capecitabine (20%). RESULTS. The median follow‐up was 5.5 months (range, 1–63 months). For all patients, the median overall survival (OS) and progression‐free survival (PFS) were 9 months and 5 months, respectively, and the 2‐year estimated OS and PFS rates were 9% and 5%, respectively. The median OS and PFS were 8.5 months and 4.2 months, respectively, in the CR group and 11.9 months and 6.4 months, respectively, in the CCR group (both P < .001). The median times to local and distant progression were 6.0 months and 5.6 months, respectively, in the CR group and 8.9 and 9.5 months, respectively, in the CCR group (P = .003 and P = .007, respectively). There was no significant difference in the patterns of failure with the use of induction chemotherapy. CONCLUSIONS. The results from this analysis indicated that, by excluding patients with rapid distant progression, induction chemotherapy may select patients with LAPC for optimal benefit from consolidative CR. The authors believe that this strategy of enriching the population of patients who receive a locoregional treatment modality merits prospective randomized evaluation. Cancer 2007. © 2007 American Cancer Society.

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Concurrent bevacizumab did not significantly increase the acute toxicity of a relatively well-tolerated chemoradiotherapy regimen. However, ulceration and bleeding in the radiation field possibly related to bevacizumab occurred when tumor involved the duodenal mucosa. The encouraging efficacy end points suggest that the further study of bevacizumab with chemoradiotherapy is warranted.

This article focuses on the physical modeling and numerical simulation of mass transfer in two‐phase bubbly flow in an airlift internal loop reactor. The objective of this article is to show the ability of computational fluid dynamics (CFD) to correctly simulate mass transfer in such a bubbly reactor. The modeling of two‐phase bubbly flow is based on the so‐called two‐fluid model derived from Reynolds‐averaged Navier–Stokes equations in two‐phase flow. From the hydrodynamic perspective, the flow is steady state. Given the steady‐state distributions of phases, interfacial area, and velocity field in the whole volume of the airlift, mass transfer is computed and the evolution of oxygen concentration in the two phases is predicted. Numerical simulations are discussed after comparison to experimental data. The simulations are validated in terms of oxygen concentration in the liquid vs. time. Then, different points are discussed, in particular, the perfectly mixed reactor assumption in the liquid phase and the spatial and temporal heterogeneity of oxygen concentration in the gas arising from oxygen impoverishment in bubbles in the downcomer. This leads to heterogeneity of the transfer driving force between the gas and the liquid. Bubble age or residence time in the airlift loop reactor has been calculated to show the weak renewal of oxygen in bubbles in the downcomer. This discussion generates questions on the estimation of a global mass transfer coefficient from experiments in such a heterogeneous airlift reactor. © 2007 American Institute of Chemical Engineers AIChE J 2007