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Intensity-modulated and image-guided radiotherapy in patients with locally advanced inoperable pancreatic cancer after preradiation chemotherapy.

Sinn M, Ganeshan R, Graf R, Pelzer U, Stieler JM, Striefler JK, Bahra M, Wust P, Riess H - ScientificWorldJournal (2014)

Bottom Line: Median RT-specific PFS for patients with prolonged PRCT > 9 months was 8.5 months compared to 5.6 months for PRCT < 9 months (P = 0.293).This effect was translated into a significantly better median RT-specific overall survival of patients in the PRCT > 9 months group, with 19.0 months compared to 8.5 months in the PRCT  <  9 months group (P = 0.049).IGRT and IMRT after PRCT are feasible and effective options for patients with LAPC after prolonged preradiation chemotherapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology and Haematology, Charité, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.

ABSTRACT

Background: Radiotherapy (RT) in patients with pancreatic cancer is still a controversial subject and its benefit in inoperable stages of locally advanced pancreatic cancer (LAPC), even after induction chemotherapy, remains unclear. Modern radiation techniques such as image-guided radiotherapy (IGRT) and intensity-modulated radiotherapy (IMRT) may improve effectiveness and reduce radiotherapy-related toxicities.

Methods: Patients with LAPC who underwent radiotherapy after chemotherapy between 09/2004 and 05/2013 were retrospectively analyzed with regard to preradiation chemotherapy (PRCT), modalities of radiotherapy, and toxicities. Progression-free (PFS) and overall survival (OS) were estimated by Kaplan-Meier curves.

Results: 15 (68%) women and 7 men (median age 64 years; range 40-77) were identified. Median duration of PRCT was 11.1 months (range 4.3-33.0). Six patients (27%) underwent conventional RT and 16 patients (73%) advanced IMRT and IGRT; median dosage was 50.4 (range 9-54) Gray. No grade III or IV toxicities occurred. Median PFS (estimated from the beginning of RT) was 5.8 months, 2.6 months in the conventional RT group (conv-RT), and 7.1 months in the IMRT/IGRT group (P = 0.029); median OS was 11.0 months, 4.2 months (conv-RT), and 14.0 months (IMRT/IGRT); P = 0.141. Median RT-specific PFS for patients with prolonged PRCT > 9 months was 8.5 months compared to 5.6 months for PRCT < 9 months (P = 0.293). This effect was translated into a significantly better median RT-specific overall survival of patients in the PRCT > 9 months group, with 19.0 months compared to 8.5 months in the PRCT  <  9 months group (P = 0.049).

Conclusions: IGRT and IMRT after PRCT are feasible and effective options for patients with LAPC after prolonged preradiation chemotherapy.

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Related in: MedlinePlus

PFS and OS IMRT/IGRT versus conventional radiotherapy calculated from the start of palliative chemotherapy.
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fig3: PFS and OS IMRT/IGRT versus conventional radiotherapy calculated from the start of palliative chemotherapy.

Mentions: If median PFS was based on the start of palliative chemotherapy as general PFS, 16.1 months were reached (95% CI, 10.1–22.1), 13.8 months (95% CI, 7.0–20.6) conventional RT, and 19.0 months (95% CI, 12.6–25.3) IMRT/IGRT (P = 0.655). Median general OS was estimated to be 19.8 months (95% CI, 13.9–25.7), 16.2 months (95% CI, 0.9–31.5) conventional RT, and 19.8 months (95% CI, 15.7–23.9) IMRT/IGRT (P = 0.556); see Figure 3.


Intensity-modulated and image-guided radiotherapy in patients with locally advanced inoperable pancreatic cancer after preradiation chemotherapy.

Sinn M, Ganeshan R, Graf R, Pelzer U, Stieler JM, Striefler JK, Bahra M, Wust P, Riess H - ScientificWorldJournal (2014)

PFS and OS IMRT/IGRT versus conventional radiotherapy calculated from the start of palliative chemotherapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4221866&req=5

fig3: PFS and OS IMRT/IGRT versus conventional radiotherapy calculated from the start of palliative chemotherapy.
Mentions: If median PFS was based on the start of palliative chemotherapy as general PFS, 16.1 months were reached (95% CI, 10.1–22.1), 13.8 months (95% CI, 7.0–20.6) conventional RT, and 19.0 months (95% CI, 12.6–25.3) IMRT/IGRT (P = 0.655). Median general OS was estimated to be 19.8 months (95% CI, 13.9–25.7), 16.2 months (95% CI, 0.9–31.5) conventional RT, and 19.8 months (95% CI, 15.7–23.9) IMRT/IGRT (P = 0.556); see Figure 3.

Bottom Line: Median RT-specific PFS for patients with prolonged PRCT > 9 months was 8.5 months compared to 5.6 months for PRCT < 9 months (P = 0.293).This effect was translated into a significantly better median RT-specific overall survival of patients in the PRCT > 9 months group, with 19.0 months compared to 8.5 months in the PRCT  <  9 months group (P = 0.049).IGRT and IMRT after PRCT are feasible and effective options for patients with LAPC after prolonged preradiation chemotherapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology and Haematology, Charité, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.

ABSTRACT

Background: Radiotherapy (RT) in patients with pancreatic cancer is still a controversial subject and its benefit in inoperable stages of locally advanced pancreatic cancer (LAPC), even after induction chemotherapy, remains unclear. Modern radiation techniques such as image-guided radiotherapy (IGRT) and intensity-modulated radiotherapy (IMRT) may improve effectiveness and reduce radiotherapy-related toxicities.

Methods: Patients with LAPC who underwent radiotherapy after chemotherapy between 09/2004 and 05/2013 were retrospectively analyzed with regard to preradiation chemotherapy (PRCT), modalities of radiotherapy, and toxicities. Progression-free (PFS) and overall survival (OS) were estimated by Kaplan-Meier curves.

Results: 15 (68%) women and 7 men (median age 64 years; range 40-77) were identified. Median duration of PRCT was 11.1 months (range 4.3-33.0). Six patients (27%) underwent conventional RT and 16 patients (73%) advanced IMRT and IGRT; median dosage was 50.4 (range 9-54) Gray. No grade III or IV toxicities occurred. Median PFS (estimated from the beginning of RT) was 5.8 months, 2.6 months in the conventional RT group (conv-RT), and 7.1 months in the IMRT/IGRT group (P = 0.029); median OS was 11.0 months, 4.2 months (conv-RT), and 14.0 months (IMRT/IGRT); P = 0.141. Median RT-specific PFS for patients with prolonged PRCT > 9 months was 8.5 months compared to 5.6 months for PRCT < 9 months (P = 0.293). This effect was translated into a significantly better median RT-specific overall survival of patients in the PRCT > 9 months group, with 19.0 months compared to 8.5 months in the PRCT  <  9 months group (P = 0.049).

Conclusions: IGRT and IMRT after PRCT are feasible and effective options for patients with LAPC after prolonged preradiation chemotherapy.

Show MeSH
Related in: MedlinePlus