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The Scientific World Journal
Volume 2014, Article ID 452089, 8 pages
http://dx.doi.org/10.1155/2014/452089
Research Article

Intensity-Modulated and Image-Guided Radiotherapy in Patients with Locally Advanced Inoperable Pancreatic Cancer after Preradiation Chemotherapy

1Department of Medical Oncology and Haematology, Charité, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
2Department of Radiooncology, Charité, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
3Department of General, Visceral and Transplantation Surgery, Charité, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany

Received 1 July 2014; Accepted 9 September 2014; Published 20 October 2014

Academic Editor: Tsair-Fwu Lee

Copyright © 2014 M. Sinn et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 (); median OS was 11.0 months, 4.2 months (conv-RT), and 14.0 months (IMRT/IGRT); . Median RT-specific PFS for patients with prolonged PRCT 9 months was 8.5 months compared to 5.6 months for PRCT 9 months (). 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 (). Conclusions. IGRT and IMRT after PRCT are feasible and effective options for patients with LAPC after prolonged preradiation chemotherapy.