Intensity modulated radiotherapy for locally advanced and metastatic pancreatic cancer: a mono-institutional retrospective analysis

Abstract

BackgroundTo evaluate the role of intensity modulated radiotherapy (IMRT) for locally advanced pancreatic cancer (LAPC) and metastatic pancreatic cancer (MPC), and the prognostic factors in the setting of multidisciplinary approach strategies.Methods63 patients with LAPC and MPC receiving IMRT in our institution were retrospectively identified. Information on patient baseline, treatment characteristics and overall survival (OS) time were collected. Data of pain relief and toxicity were evaluated. Univariate and multivariate analyses were conducted to investigate the prognostic factors.ResultsAll patients received IMRT with a median dose of 46.0 Gy. The median OS for LAPC and MPC patients were 15.7 months and 8.0 months, respectively (p = 0.029). Symptomatic improvements were observed in the 44 patients with abdominal/back pain after radiotherapy (RT) or concurrent chemoradiotherapy (CCRT), particularly in those with severe pain. Only 13.9% and 14.8% cases presented Grade ≥ 3 hematologic toxicities in RT and CCRT group, while no cases developed Grade ≥ 3 non-hematologic toxicities in both groups. Multivariate analysis indicated that tumors located in pancreas body/tail (HR 0.28, p = 0.008), pretreatment CA19-9 < 1000 U/mL (HR 0.36, p = 0.029) and concurrent chemotherapy (HR 0.37, p = 0.016) were independent favorable predictors for OS.ConclusionsCCRT further improved OS for LAPC and MPC with acceptable toxicities, and use of RT markedly alleviated pain. Tumors located in pancreas body/tail, pretreatment CA19-9 level of < 1000 U/mL and CCRT were associated with better OS. However, regional intra-arterial chemotherapy did not show any survival benefit in our study.

Pain in pancreatic cancer: review of medical and surgical remedies

“…Wang et al . in their study reported decrease in pain intensity in 44 of the 63 (70%) patients who received intensity modulated radiation therapy . Similar results are presented in another article in which an effectiveness of stereotactic body radiotherapy using CyberKnife was evaluated .…”

Prognostic value of glypican‑1 for patients with advanced pancreatic cancer following regional intra‑arterial chemotherapy

“…However, this treatment has a low response rate and increases the risk of severe side effects, including cytopenia and bone marrow suppression (30,31). Arterial infusion, including RIAC, has been used as an alternative strategy to increase the survival rates for patients with pancreatic cancer (19,30,32). RIAC delivers a high concentration of drugs into the artery connected to the tumor and provides patients an optimal therapeutic approach, particularly for APC (33,34).…”

“…RIAC delivers a high concentration of drugs into the artery connected to the tumor and provides patients an optimal therapeutic approach, particularly for APC (33,34). Although RIAC is not a routine treatment for pancreatic cancer, clinical trials have identified that RIAC achieves a significant benefit in terms of overall survival rates and symptomatic control in patients with pancreatic cancer (5,32).…”

Treatment planning based on water density image generated using dual‐energy computed tomography for pancreatic cancer with contrast‐enhancing agent: Phantom and clinical study

“…First, we carried out treatment planning by using a 3D-CRT technique, whereas intensity-modulated radiotherapy is being used increasingly for patients with pancreatic cancer. 23 Second, the accuracy of the conversion into the RED and the MD using the WDI was investigated for 15 mg/mL iodine at the maximum density in the phantom study; however, the iodine density in patients may be larger at the aorta and kidneys, which are strongly enhanced by the contrast-enhancing agent in the pancreatic phase image. Thus, our phantom study could not assess the accuracy of the conversion of the WDI to the RED and the MD for iodine material >15 mg/mL.…”