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
. 2014:2014:452089.
doi: 10.1155/2014/452089. Epub 2014 Oct 20.

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

M Sinn  1 , R Ganeshan  1 , R Graf  2 , U Pelzer  1 , J M Stieler  1 , J K Striefler  1 , M Bahra  3 , P Wust  2 , H Riess  1
Affiliations

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

M Sinn et al. ScientificWorldJournal. 2014.

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Radiation plan. Representative dose distribution of a Tomotherapy plan for a pancreatic recurrency, given in three orthogonal planes: the dark red contour delineates the macroscopic tumor (ascertained by PET) with a prescribed dose of 64.5 Gy. The planning target volume (PTV) is light red and includes the adjacent lymph nodes. The prescribed dose is 51 Gy. Dose coverage of >95% is achieved. The surrounding normal tissues liver, kidneys (light blue), intestine (magenta), and spinal cord (orange) are particularly spared. In this patient only a small part of the intestine (<100 mL) is exposed to a dose > 30 Gy (blue region). Note the high conformality as well as the steep dose gradient from 60 below 30 Gy in selected directions.
Figure 2
Figure 2
PFS and OS IMRT/IGRT versus conventional radiotherapy calculated from the start of RT.
Figure 3
Figure 3
PFS and OS IMRT/IGRT versus conventional radiotherapy calculated from the start of palliative chemotherapy.
Figure 4
Figure 4
PFS and OS calculated from the he start of RT: duration of preradiation chemotherapy > 9 months versus ≤ 9 months.
See this image and copyright information in PMC

References

    1. Vincent A., Herman J., Schulick R., Hruban R. H., Goggins M. Pancreatic cancer. The Lancet. 2011;378(9791):607–620. doi: 10.1016/S0140-6736(10)62307-0. - DOI - PMC - PubMed
    1. Loehrer P. J., Sr., Feng Y., Cardenes H., Wagner L., Brell J. M., Cella D., Flynn P., Ramanathan R. K., Crane C. H., Alberts S. R., Benson A. B., III Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group trial. Journal of Clinical Oncology. 2011;29(31):4105–4112. doi: 10.1200/JCO.2011.34.8904. - DOI - PMC - PubMed
    1. Huguet F., Girard N., Séblain-El Guerche C., Hennequin C., Mornex F., Azria D. Chemoradiotherapy in the management of locally advanced pancreatic carcinoma: a qualitative systematic review. Journal of Clinical Oncology. 2009;27(13):2269–2277. doi: 10.1200/JCO.2008.19.7921. - DOI - PubMed
    1. Huguet F., Goodman K. A., Azria D., Racadot S., Abrams R. A. Radiotherapy technical considerations in the management of locally advanced pancreatic cancer: American-French consensus recommendations. International Journal of Radiation Oncology Biology Physics. 2012;83(5):1355–1364. doi: 10.1016/j.ijrobp.2011.11.050. - DOI - PubMed
    1. Son S. H., Song J. H., Choi B. O., Kang Y.-N., Lee M. A., Kang K. M., Jang H. S. The technical feasibility of an image-guided intensity-modulated radiotherapy (IG-IMRT) to perform a hypofractionated schedule in terms of toxicity and local control for patients with locally advanced or recurrent pancreatic cancer. Radiation Oncology. 2012;7(1, article 203) doi: 10.1186/1748-717X-7-203. - DOI - PMC - PubMed

Substances

LinkOut - more resources