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. 2020 Feb;146(2):417-428.
doi: 10.1007/s00432-019-03066-z. Epub 2019 Oct 30.

Clinical outcomes and prognostic factors of stereotactic body radiation therapy combined with gemcitabine plus capecitabine for locally advanced unresectable pancreatic cancer

Ze-Tian Shen  1 , Han Zhou  1 , Ao-Mei Li  1 , Xiao-Qin Ji  1 , Chang-Chen Jiang  1 , Xi Yuan  1 , Bing Li  1 , Xi-Xu Zhu  2 , Gui-Chun Huang  3
Affiliations

Clinical outcomes and prognostic factors of stereotactic body radiation therapy combined with gemcitabine plus capecitabine for locally advanced unresectable pancreatic cancer

Ze-Tian Shen et al. J Cancer Res Clin Oncol. 2020 Feb.

Abstract

Purpose: This study aimed to evaluate the clinical outcomes, toxicity, and prognostic factors of SBRT combined with gemcitabine plus capecitabine (GEM-CAP) in treating locally advanced pancreatic cancer (LAPC).

Methods: A total of 56 patients with LAPC treated with SBRT combined with GEM-CAP were reviewed from October 2010 to October 2016. The median total prescription dose at five fractions was 40 Gy (30-50 Gy). The patients were subjected to two cycles of GEM-CAP before SBRT. GEM-CAP chemotherapy was then offered for four cycles or until disease tolerance or progression. The primary endpoints included overall survival (OS) and progression-free survival (PFS).

Results: The median OS and PFS from the date of diagnosis was 19 (95% CI 14.6-23.4) and 12 months (95% CI 8.34-15.66), respectively. The 1-year and 2-year survival rates were 82.1% and 35.7%, whereas the 1-year and 2-year PFS rates were 48.2% and 14.3%, respectively. The median carbohydrate antigen 19-9-determined PFS time was 11 months (95% CI 5.77-16.24). Multivariate analysis demonstrated that tumor diameter, lymph node metastasis, pre-treatment CA19-9 level, and post-treatment CA19-9 decline were independent prognostic factors (p < 0.05). Acute toxicity was minimal, with two cases (3.6%) experiencing grade 3 duodenal obstruction. No adverse events greater than grade 3 occurred. In late toxicity, three patients (5.4%) developed grade 3 gastrointestinal toxicity and two (3.6%) suffered from perforation caused by grade 4 radiation enteritis and intestinal fistula.

Conclusions: The combination of Cyberknife SBRT and GEM-CAP achieved excellent efficacy with acceptable toxicity for LAPC.

Keywords: CyberKnife; Locally advanced pancreatic cancer; Prognostic factors; Stereotactic body radiation therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Kaplan–Meier analysis of overall survival for patients with LAPC
Fig. 2
Fig. 2
Kaplan–Meier analysis of progression free survival for patients with LAPC
Fig. 3
Fig. 3
Kaplan–Meier analysis of carbohydrate antigen 19-9-progression-free survival for patients with LAPC
Fig. 4
Fig. 4
Kaplan–Meier overall survival curves: CA19-9 < 37 IU/ml (n = 23, solid lines) versus CA19-9 > 37 IU/ml (n = 33, dashed lines) patients with LAPC (p < 0.001)
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