Pancreatic Cancer: Feasibility and Outcome After Radiochemotherapy with High Dose External Radiotherapy for Non-resected and R1 Resected Patients

Abstract

BackgroundNon-resected locally advanced and microscopic positive-margin resected (R1) pancreatic adenocarcinoma are associated with a dismal prognosis. The combination of high dose radiotherapy and concomitant chemotherapy is among the strategies that are used to improve the outcome. The aims of this study were to evaluate the acute and late toxicities and patients' outcome in a retrospective study from a single center.Material and methodsFrom 2009 to 2015, 24 patients, with non-resected locally advanced or R1 resected pancreatic adenocarcinoma, have been treated with concomitant radiochemotherapy, with a median dose of 60 Gy and gemcitabine (50 mg/m2 administered bi-weekly). The acute and late toxicities were evaluated during and after the treatment.ResultsThe actuarial overall survival rates were 39% at 24 months and 8.6% at 36 months. The disease-free survival rates were 32.5% at 24 months and 12.2% at 36 months. Acute toxicities were mainly grade 1 (G1) to grade 2 (G2) except for one patient who presented with severe digestive bleeding potentially linked to the treatment. Late toxicities consisted mainly of G1 digestive toxicities.ConclusionThis study confirms the feasibility of high dose radiotherapy combined with gemcitabine-based chemotherapy in patients with locally advanced pancreatic adenocarcinoma. While the outcome remains unsatisfactory, some patients seem to have benefited from this aggressive therapy, which merits to be investigated further.

Prophylactic dendritic cell vaccination controls pancreatic cancer growth in a mouse model

“…PDAC recurrence rate after surgical resection is up to 60% in the first year, and 5-year survival of patients who underwent complete resection is only 25% (3). Nonsurgical therapies for PDAC include systemic chemotherapies (4-7), molecularly-targeted therapies (8), conventional ablative therapies (9)(10)(11)(12)(13), and radiotherapy (14)(15)(16)(17); however, they have so far offered little or no survival benefit (4,6,7,11,17).…”

<p>Harmine suppresses the proliferation of pancreatic cancer cells and sensitizes pancreatic cancer to gemcitabine treatment</p>

“…The anatomical location of the pancreatic gland is close to many important organs, main arteries and veins. Consequently, a large proportion of patients with pancreatic carcinoma (80–85%) present with an extension to adjacent organs or distant metastases, rendering surgical resection 3. Currently, gemcitabine is recommended as the first-line drug for the treatment of advanced pancreatic cancer 4.…”

Toll-like receptor 2 and Toll-like receptor 4 exhibit distinct regulation of cancer cell stemness mediated by cell death-induced high-mobility group box 1

“…The purpose of radiotherapy is to promote tumor cell death. However, mounting publications have demonstrated that dying tumor cells can induce the accelerated regrowth of the resident cancer cells and form a special microenvironment for tumor recurrence [ [3] , [4] , [5] ], making the role of radiotherapy in treating of PC controversial [ 6 ].…”