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01.09.2013 | Original article

Intensity modulated radiotherapy as neoadjuvant chemoradiation for the treatment of patients with locally advanced pancreatic cancer

Outcome analysis and comparison with a 3D-treated patient cohort

verfasst von: Prof. Dr. S.E. Combs, MD, D. Habermehl, MD, K. Kessel, F. Bergmann, MD, J. Werner, MD, I. Brecht, P. Schirmacher, D. Jäger, MD, M.W. Büchler, MD, J. Debus, MD PhD

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 9/2013

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Abstract

Background

To evaluate outcome after intensity modulated radiotherapy (IMRT) compared to 3D conformal radiotherapy (3D-RT) as neoadjuvant treatment in patients with locally advanced pancreatic cancer (LAPC).

Materials and methods

In total, 57 patients with LAPC were treated with IMRT and chemotherapy. A median total dose of 45 Gy to the PTV__baseplan and 54 Gy to the PTV__boost in single doses of 1.8 Gy for the PTV__baseplan and median single doses of 2.2 Gy in the PTV__boost were applied. Outcomes were evaluated and compared to a large cohort of patients treated with 3D-RT.

Results

Overall treatment was well tolerated in all patients and IMRT could be completed without interruptions. Median overall survival was 11 months (range 5–37.5 months). Actuarial overall survival at 12 and 24 months was 36 % and 8 %, respectively. A significant impact on overall survival could only be observed for a decrease in CA 19-9 during treatment, patients with less pre-treatment CA 19-9 than the median, as well as weight loss during treatment. Local progression-free survival was 79 % after 6 months, 39 % after 12 months, and 13 % after 24 months. No factors significantly influencing local progression-free survival could be identified. There was no difference in overall and progression-free survival between 3D-RT and IMRT. Secondary resectability was similar in both groups (26 % vs. 28 %). Toxicity was comparable and consisted mainly of hematological toxicity due to chemotherapy.

Conclusion

IMRT leads to a comparable outcome compared to 3D-RT in patients with LAPC. In the future, the improved dose distribution, as well as advances in image-guided radiotherapy (IGRT) techniques, may improve the use of IMRT in local dose escalation strategies to potentially improve outcome.

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Titel: Intensity modulated radiotherapy as neoadjuvant chemoradiation for the treatment of patients with locally advanced pancreatic cancer
Outcome analysis and comparison with a 3D-treated patient cohort
verfasst von: Prof. Dr. S.E. Combs, MD
D. Habermehl, MD
K. Kessel
F. Bergmann, MD
J. Werner, MD
I. Brecht
P. Schirmacher
D. Jäger, MD
M.W. Büchler, MD
J. Debus, MD PhD
Publikationsdatum: 01.09.2013
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 9/2013
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-013-0391-5

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Intensity modulated radiotherapy as neoadjuvant chemoradiation for the treatment of patients with locally advanced pancreatic cancer

Outcome analysis and comparison with a 3D-treated patient cohort

Abstract

Background

Materials and methods

Results

Conclusion

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Abstract

Background

Materials and methods

Results

Conclusion

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