Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Jan 31:8:27.
doi: 10.1186/1748-717X-8-27.

Chemoradiation in patients with isolated recurrent pancreatic cancer - therapeutical efficacy and probability of re-resection

Daniel Habermehl  1 , Ingo C Brecht, Frank Bergmann, Thomas Welzel, Stefan Rieken, Jens Werner, Peter Schirmacher, Markus W Büchler, Jürgen Debus, Stephanie E Combs
Affiliations

Chemoradiation in patients with isolated recurrent pancreatic cancer - therapeutical efficacy and probability of re-resection

Daniel Habermehl et al. Radiat Oncol. .

Abstract

Background: In the present retrospective analysis we analysed the therapeutic outcome of a set of patients, who were treated with chemoradiation (CRT) for recurrent pancreatic cancer (RPC) in a single institution.

Patients and methods: Forty-one patients had a history of primary resection for pancreatic cancer. In case of an unresectable recurrency patients were treated with CRT at our institution between 2002 and 2010 with a median dose of 48.4 Gy (range 39.6-54 Gy). Concurrent chemotherapy regimes included Gemcitabine (GEM) in 37/41 patients (90%) and Fluorouracil (FU) or Capecitabine (CAP) in 4/41 patients (10%). Patients were re-evaluated after CRT with computed tomography and/or explorative laparotomy. During re-resection or laparotomy 15 patients received an additional intraoperative radiotherapy (IORT) with a median dose of 15 Gy (range 12-15 Gy). Median age was 65 years (range 39-76 years) and there were 26 male and 15 female patients.

Results: The median overall survival (mOS), local control (LC) and progression-free survival (PFS) were 16.1, 13.8 and 6.9 months respectively for all patients after the first day of CRT. Re-resection was possible in five patients (12%) and a complete remission (CR) as defined by tumor-free biopsy was seen in 6 patients (15%). When re-resection could be achieved after CRT mOS was improved to 28.3 months (n = 5 patients, 95%-CI 10.2 - 46.3 months). Patients receiving IORT had a significantly improved mOS compared to no IORT (p = 0.034). Fifteen patients (37%) experienced a local tumour progression and main site of distant metastasis was the liver (11 patients, 27%).Overall treatment-related toxicity was mild, grade III hematologic toxicity was observed in 11 patients (27%).

Conclusion: In summary we observed a good therapeutic response with mild to moderate toxicity levels for CRT in RPC. Overall survival and PFS were clearly improved in case of induction of a complete remission (tumor-free biopsies) or after achieving a re-resection, thus providing a curative intended therapy even in case of disease recurrence.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Kaplan-Meier curve for local control of all patients.
Figure 2
Figure 2
Kaplan-Meier curve for progression-free survival of all patients.
Figure 3
Figure 3
Kaplan-Meier curve for progression-free survival of all patients stratified byIORT treatment (yes vs. no).
Figure 4
Figure 4
Kaplan-Meier curve for overall survival of all patients.
Figure 5
Figure 5
Kaplan-Meier curve for overall survival of all patients stratified by IORT treatment (yes vs. no).
See this image and copyright information in PMC

References

    1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10–29. doi: 10.3322/caac.20138. - DOI - PubMed
    1. Cleary SP, Gryfe R, Guindi M. et al.Prognostic factors in resected pancreatic adenocarcinoma: analysis of actual 5-year survivors. J Am Coll Surg. 2004;198:722–731. doi: 10.1016/j.jamcollsurg.2004.01.008. - DOI - PubMed
    1. Sohn TA, Yeo CJ, Cameron JL. et al.Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg. 2000;4:567–579. doi: 10.1016/S1091-255X(00)80105-5. - DOI - PubMed
    1. Van den Broeck A, Sergeant G, Ectors N, Van Steenbergen W, Aerts R, Topal B. Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. Eur J Surg Oncol. 2009;35:600–604. doi: 10.1016/j.ejso.2008.12.006. - DOI - PubMed
    1. Hishinuma S, Ogata Y, Tomikawa M, Ozawa I, Hirabayashi K, Igarashi S. Patterns of recurrence after curative resection of pancreatic cancer, based on autopsy findings. J Gastrointest Surg. 2006;10:511–518. doi: 10.1016/j.gassur.2005.09.016. - DOI - PubMed

MeSH terms