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http://dx.doi.org/10.3857/jkstro.2009.27.3.145

The Results of Radiotherapy in Locally Advanced, Unresectable Pancreatic Cancer  

Jang, Hyun-Soo (Department of Radiation Oncology, Ajou University School of Medicine)
Kang, Seung-Hee (Department of Radiation Oncology, Ajou University School of Medicine)
Kim, Sang-Won (Department of Radiation Oncology, Ajou University School of Medicine)
Chun, Mi-Son (Department of Radiation Oncology, Ajou University School of Medicine)
Jo, Sun-Mi (Department of Radiation Oncology, Ajou University School of Medicine)
Lim, Jun-Chul (Department of Radiation Oncology, Ajou University School of Medicine)
Oh, Young-Taek (Department of Radiation Oncology, Ajou University School of Medicine)
Kang, Seok-Yun (Department of Medical Oncology, Ajou University School of Medicine)
Publication Information
Radiation Oncology Journal / v.27, no.3, 2009 , pp. 145-152 More about this Journal
Abstract
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 ($\geq$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 $\geq$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.
Keywords
Pancreatic cancer; Concurrent chemoradiotherapy; Radiotherapy; CA19-9;
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