Skip to main content
Erschienen in: Journal of Gastroenterology 6/2014

01.06.2014 | Original Article—Liver, Pancreas, and Biliary Tract

Upper gastrointestinal complications associated with gemcitabine-concurrent proton radiotherapy for inoperable pancreatic cancer

verfasst von: Kento Takatori, Kazuki Terashima, Rihito Yoshida, Aya Horai, Shinya Satake, Takayuki Ose, Naoto Kitajima, Yoshikazu Kinoshita, Yusuke Demizu, Nobukazu Fuwa

Erschienen in: Journal of Gastroenterology | Ausgabe 6/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

Little is known about acute upper gastrointestinal (GI) complications associated with gemcitabine-concurrent proton radiotherapy (GPT) for inoperable pancreatic cancer. We investigated acute GI complications following GPT in patients with inoperable pancreatic cancer using small-bowel endoscopy.

Methods

This prospective single center observational study was conducted at the Hyogo Ion Beam Medical Center from January 2010 to January 2012. Ninety-one patients who had clinically and medically inoperable pancreatic cancer treated by GPT were analyzed. Endoscopic examinations were performed before and after GPT to clarify the incidence rates of radiation-induced ulcers, GI hemorrhage, and GI perforation associated with GPT.

Results

Post-treatment endoscopic examinations revealed that 45 (49.4 %) patients had radiation-induced ulcers in the stomach and duodenum. Of those, many ulcerative lesions were found in the lower stomach (51 %) and horizontal part of the duodenum (39 %), regardless of the primary tumor site in the pancreas. Neither GI hemorrhage, nor perforation, was found in post-treatment endoscopy examinations.

Conclusion

Approximately half of the patients treated with GPT for inoperable pancreatic cancer exhibited radiation-induced ulcers in the stomach and duodenum.
Literatur
1.
Zurück zum Zitat Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.PubMedCrossRef Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.PubMedCrossRef
2.
Zurück zum Zitat de Lange SM, van Groeningen CJ, Meijer OW, Cuesta MA, Langendijk JA, van Riel JM, et al. Gemcitabine-radiotherapy in patients with locally advanced pancreatic cancer. Eur J Cancer. 2002;38:1212–7.PubMedCrossRef de Lange SM, van Groeningen CJ, Meijer OW, Cuesta MA, Langendijk JA, van Riel JM, et al. Gemcitabine-radiotherapy in patients with locally advanced pancreatic cancer. Eur J Cancer. 2002;38:1212–7.PubMedCrossRef
4.
Zurück zum Zitat Burris HA 3rd, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 1997;15:2403–13.PubMed Burris HA 3rd, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 1997;15:2403–13.PubMed
5.
Zurück zum Zitat Cardenes HR, Moore AM, Johnson CS, Yu M, Helft P, Chiorean EG, et al. A phase II study of gemcitabine in combination with radiation therapy in patients with localized, unresectable, pancreatic cancer: a Hoosier Oncology Group Study. Am J Clin Oncol. 2011;34:460–5.PubMedCrossRef Cardenes HR, Moore AM, Johnson CS, Yu M, Helft P, Chiorean EG, et al. A phase II study of gemcitabine in combination with radiation therapy in patients with localized, unresectable, pancreatic cancer: a Hoosier Oncology Group Study. Am J Clin Oncol. 2011;34:460–5.PubMedCrossRef
6.
Zurück zum Zitat Terashima K, Demizu Y, Hashimoto N, Jin D, Mima M, Fujii O, et al. A phase I/II study of gemcitabine-concurrent proton radiotherapy for locally advanced pancreatic cancer without distant metastasis. Radiother Oncol. 2012;103:25–31.PubMedCrossRef Terashima K, Demizu Y, Hashimoto N, Jin D, Mima M, Fujii O, et al. A phase I/II study of gemcitabine-concurrent proton radiotherapy for locally advanced pancreatic cancer without distant metastasis. Radiother Oncol. 2012;103:25–31.PubMedCrossRef
7.
Zurück zum Zitat Schulz-Ertner D, Tsujii H. Particle radiation therapy using proton and heavier ion beams. J Clin Oncol. 2007;25:953–64.PubMedCrossRef Schulz-Ertner D, Tsujii H. Particle radiation therapy using proton and heavier ion beams. J Clin Oncol. 2007;25:953–64.PubMedCrossRef
8.
Zurück zum Zitat Takagi K, Takada T, Amano H, Yoshida M, Miura F, Isaka T, et al. Late hemorrhage after pancreatoduodenectomy and heavy ion beam therapy. J Hepatobiliary Pancreat Surg. 2007;14:331–5.PubMedCrossRef Takagi K, Takada T, Amano H, Yoshida M, Miura F, Isaka T, et al. Late hemorrhage after pancreatoduodenectomy and heavy ion beam therapy. J Hepatobiliary Pancreat Surg. 2007;14:331–5.PubMedCrossRef
9.
Zurück zum Zitat Wilson RR. Radiological use of fast protons. Radiology. 1946;47:487–91.PubMed Wilson RR. Radiological use of fast protons. Radiology. 1946;47:487–91.PubMed
10.
Zurück zum Zitat Kagawa K, Murakami M, Hishikawa Y, Abe M, Akagi T, Yanou T, et al. Preclinical biological assessment of proton and carbon ion beams at Hyogo Ion Beam Medical Center. Int J Radiat Oncol Biol Phys. 2002;54:928–38.PubMedCrossRef Kagawa K, Murakami M, Hishikawa Y, Abe M, Akagi T, Yanou T, et al. Preclinical biological assessment of proton and carbon ion beams at Hyogo Ion Beam Medical Center. Int J Radiat Oncol Biol Phys. 2002;54:928–38.PubMedCrossRef
11.
Zurück zum Zitat Kavanagh BD, Pan CC, Dawson LA, Das SK, Li XA, Ten Haken RK, et al. Radiation dose-volume effects in the stomach and small bowel. Int J Radiat Oncol Biol Phys. 2010;76:S101–7.PubMedCrossRef Kavanagh BD, Pan CC, Dawson LA, Das SK, Li XA, Ten Haken RK, et al. Radiation dose-volume effects in the stomach and small bowel. Int J Radiat Oncol Biol Phys. 2010;76:S101–7.PubMedCrossRef
12.
Zurück zum Zitat Yeomans ND, Naesdal J. Systematic review: ulcer definition in NSAID ulcer prevention trials. Aliment Pharmacol Ther. 2008;27:465–72.PubMedCrossRef Yeomans ND, Naesdal J. Systematic review: ulcer definition in NSAID ulcer prevention trials. Aliment Pharmacol Ther. 2008;27:465–72.PubMedCrossRef
13.
Zurück zum Zitat Shibuya K, Oya N, Fujii T, Doi R, Nakamura A, Matsuo Y, et al. Phase II study of radiation therapy combined with weekly low-dose gemcitabine for locally advanced, unresectable pancreatic cancer. Am J Clin Oncol. 2011;34:115–9.PubMed Shibuya K, Oya N, Fujii T, Doi R, Nakamura A, Matsuo Y, et al. Phase II study of radiation therapy combined with weekly low-dose gemcitabine for locally advanced, unresectable pancreatic cancer. Am J Clin Oncol. 2011;34:115–9.PubMed
14.
Zurück zum Zitat Hamilton CR, Horwich A, Bliss JM, Peckham MJ. Gastrointestinal morbidity of adjuvant radiotherapy in stage I malignant teratoma of the testis. Radiother Oncol. 1987;10:85–90.PubMedCrossRef Hamilton CR, Horwich A, Bliss JM, Peckham MJ. Gastrointestinal morbidity of adjuvant radiotherapy in stage I malignant teratoma of the testis. Radiother Oncol. 1987;10:85–90.PubMedCrossRef
15.
Zurück zum Zitat Didolkar MS, Coleman CW, Brenner MJ, Chu KU, Olexa N, Stanwyck E, et al. Image-guided stereotactic radiosurgery for locally advanced pancreatic adenocarcinoma results of first 85 patients. J Gastrointest Surg. 2010;14:1547–59.PubMedCrossRef Didolkar MS, Coleman CW, Brenner MJ, Chu KU, Olexa N, Stanwyck E, et al. Image-guided stereotactic radiosurgery for locally advanced pancreatic adenocarcinoma results of first 85 patients. J Gastrointest Surg. 2010;14:1547–59.PubMedCrossRef
16.
Zurück zum Zitat Adamu MA, Schottker B, Weck MN, Brenner H. Helicobacter pylori infection is strongly associated with gastric and duodenal ulcers in a large prospective study. Clin Gastroenterol Hepatol. 2012;10:487–93.PubMedCrossRef Adamu MA, Schottker B, Weck MN, Brenner H. Helicobacter pylori infection is strongly associated with gastric and duodenal ulcers in a large prospective study. Clin Gastroenterol Hepatol. 2012;10:487–93.PubMedCrossRef
17.
Zurück zum Zitat Sostres C, Gargallo CJ, Arroyo MT, Lanas A. Adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs, aspirin and coxibs) on upper gastrointestinal tract. Best Pract Res Clin Gastroenterol. 2010;24:121–32.PubMedCrossRef Sostres C, Gargallo CJ, Arroyo MT, Lanas A. Adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs, aspirin and coxibs) on upper gastrointestinal tract. Best Pract Res Clin Gastroenterol. 2010;24:121–32.PubMedCrossRef
18.
Zurück zum Zitat Murphy JD, Adusumilli S, Griffith KA, Ray ME, Zalupski MM, Lawrence TS, et al. Full-dose gemcitabine and concurrent radiotherapy for unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys. 2007;68:801–8.PubMedCrossRef Murphy JD, Adusumilli S, Griffith KA, Ray ME, Zalupski MM, Lawrence TS, et al. Full-dose gemcitabine and concurrent radiotherapy for unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys. 2007;68:801–8.PubMedCrossRef
19.
Zurück zum Zitat Wong JC, Lu DS. Staging of pancreatic adenocarcinoma by imaging studies. Clin Gastroenterol Hepatol. 2008;6:1301–8.PubMedCrossRef Wong JC, Lu DS. Staging of pancreatic adenocarcinoma by imaging studies. Clin Gastroenterol Hepatol. 2008;6:1301–8.PubMedCrossRef
20.
Zurück zum Zitat Coia LR, Myerson RJ, Tepper JE. Late effects of radiation therapy on the gastrointestinal tract. Int J Radiat Oncol Biol Phys. 1995;31:1213–36.PubMedCrossRef Coia LR, Myerson RJ, Tepper JE. Late effects of radiation therapy on the gastrointestinal tract. Int J Radiat Oncol Biol Phys. 1995;31:1213–36.PubMedCrossRef
Metadaten
Titel
Upper gastrointestinal complications associated with gemcitabine-concurrent proton radiotherapy for inoperable pancreatic cancer
verfasst von
Kento Takatori
Kazuki Terashima
Rihito Yoshida
Aya Horai
Shinya Satake
Takayuki Ose
Naoto Kitajima
Yoshikazu Kinoshita
Yusuke Demizu
Nobukazu Fuwa
Publikationsdatum
01.06.2014
Verlag
Springer Japan
Erschienen in
Journal of Gastroenterology / Ausgabe 6/2014
Print ISSN: 0944-1174
Elektronische ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-013-0857-3

Weitere Artikel der Ausgabe 6/2014

Journal of Gastroenterology 6/2014 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.