Concurrent chemoradiotherapy with or without induction chemotherapy versus chemotherapy alone in patients with locally advanced pancreatic cancer

Abstract

Background/aim: The role of chemoradiotherapy (CRT) in the management of locally advanced pancreatic cancer is controversial. We aimed to explore this issue by retrospectively comparing the efficacy of concurrent CRT with or without induction (CT) versus CT alone in patients with locally advanced pancreatic cancer (LAPC).

Patients and methods: Between January 2006 and December 2012, 55 patients with biopsy-proven LAPC were treated either with CRT (n=31) or CT alone (n=24) at the authors' Institution. CT before or after CRT were allowed. Radiation therapy was delivered with a median dose of 50.4 Gy in a single fraction of 1.8 Gy and concurrent CT was typically given with gemcitabine at a dose of 400 mg/m2 weekly. The majority of CT was gemcitabine-based (96%). Progression-free survival and overall survival were calculated from the date of diagnosis to the date of progression and to the date of death or last follow-up, respectively.

Results: Patients' characteristics were not significantly different between the CRT group and CT-alone group. Nineteen (61%) patients received scheduled radiation dose of 50.4 Gy. The median cumulative dose of maintenance CT with gemcitabine after CRT was 6,500 mg/m2. The median survival was 14.6 versus 8.1 months (p=0.001) and progression-free survival was 8.7 versus 4.9 months (p<0.001) for the CRT group and CT-alone group, respectively.

Conclusion: Patients with LAPC treated with CRT conferred more favorable survival than those who did not receive CRT. CRT should be considered integrating into the management of LAPC.

Keywords: Concomitant chemoradiotherapy; chemotherapy; pancreatic cancer.