Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-27T02:55:22.327Z Has data issue: false hasContentIssue false
  • English
  • Français

Concurrent high-dose intensity-modulated radiotherapy and chemotherapy for unresectable locally advanced and metastatic pancreatic cancer: a pilot study

Published online by Cambridge University Press:  18 January 2021

Kenichi Matsumoto Open the ORCID record for Kenichi Matsumoto [Opens in a new window] ,
Akihiko Miyamoto ,
Tomoya Kawase ,
Taro Murai  and
Yuta Shibamoto
Kenichi Matsumoto*
Affiliation:
Department of Radiotherapy, Obihiro, Hokkaido, Japan
Akihiko Miyamoto
Affiliation:
Department of Radiotherapy, Obihiro, Hokkaido, Japan
Tomoya Kawase
Affiliation:
Gastroenterogy, Hokuto Hospital, Obihiro, Hokkaido, Japan
Taro Murai
Affiliation:
Department of Radiology, Nagoya City University Graduate School of Medicine, Nagoya, Aichi, Japan
Yuta Shibamoto
Affiliation:
Department of Radiology, Nagoya City University Graduate School of Medicine, Nagoya, Aichi, Japan
*
Author for correspondence: Kenichi Matsumoto, Department of Radiotherapy, Hokuto Hospital, 7-5 Inadacho, Obihiro, Hokkaido080-0833, Japan. Tel: +81-155-48-8000. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim:

To evaluate the efficacy of concurrent chemotherapy and high-dose (≥55 Gy) intensity-modulated radiotherapy (CCIMRT) in comparison with chemotherapy alone and intensity-modulated radiotherapy (IMRT) alone for unresectable locally advanced or metastatic pancreatic cancer.

Methods:

Forty-six patients with pancreatic cancer undergoing CCIMRT (n = 17), chemotherapy alone (n = 16) or IMRT alone (n = 13) were analysed. Overall survival (OS), locoregional progression-free survival (LRPFS) and gastrointestinal toxicities were evaluated. The median radiation dose was 60 Gy (range, 55–60) delivered in a median of 25 fractions (range, 24–30). Gemcitabine (GEM) alone, GEM + S-1, S-1 alone, FOLFIRINOX and GEM + nab-paclitaxel were used in CCIMRT and chemo-monotherapy.

Results:

The 1-year OS rate was 69% in the CCIMRT group, 27% in the chemotherapy group and 38% in the IMRT group (p = 0·12). The 1-year LRPFS rate was 73, 0 and 40% in the 3 groups, respectively (p = 0·012). Acute Grade ≥ 2 gastrointestinal toxicity (nausea, diarrhea) was observed in 12% (2/17) in the CCIMRT group, 25% (4/16) in the chemotherapy group and 7·7% (1/13) in the IMRT group (p = 0·38). Late Grade 3 gastrointestinal bleeding was observed in 6·3% (1/16) in the chemotherapy group.

Conclusion:

High-dose CCIMRT yielded acceptable toxicity and favorable OS and LRPFS.

Keywords

concurrent chemoradiotherapyintensity-modulated radiotherapypancreatic cancertomotherapy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 2 , June 2022 , pp. 239 - 244
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Willett, C G, Czito, B G, Bendell, J C et al. Locally advanced pancreatic cancer. J Clin Oncol 2005; 23: 4538–4544.CrossRefGoogle ScholarPubMed
Krishnan, S, Rana, V, Janjan, N A et al. Induction chemotherapy selects patients with locally advanced, unresectable pancreatic cancer for optimal benefit from consolidative chemoradiation therapy. Cancer 2007; 110: 47–55.CrossRefGoogle ScholarPubMed
Tsavaris, N, Tentas, K, Tzivras, M et al. Combined epirubicin, 5-fluorouracil and folinic acid vs no treatment for patients with advanced pancreatic cancer: a prospective comparative study. J Chemother 1998; 10: 331–337.CrossRefGoogle ScholarPubMed
Shibamoto, Y, Nishimura, Y, Abe, M. Intraoperative radiotherapy and hyperthermia for unresectable pancreatic cancer. Hepato-Gastroenterology 1996; 43: 326–332.Google ScholarPubMed
Loehrer, P J Sr, Feng, Y, Cardenes, H et al. Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group trial. J Clin Oncol 2011; 29: 4105–4112.CrossRefGoogle ScholarPubMed
Gastrointestinal Tumor Study Group. Treatment of locally unresectable carcinoma of the pancreas: comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone. J Natl Cancer Inst 1988; 80: 751–755.CrossRefGoogle Scholar
Chauffert, B, Mornex, F, Bonnetain, F et al. Phase III trial comparing intensive induction chemoradiotherapy (60 Gy, infusional 5-FU and intermittent cisplatin) followed by maintenance gemcitabine with gemcitabine alone for locally advanced unresectable pancreatic cancer. Definitive results of the 2000-01 FFCD/SFRO study. Ann Oncol 2008; 19: 1592–1599.CrossRefGoogle ScholarPubMed
Klaassen, D J, MacIntyre, J M, Catton, G E et al. Treatment of locally unresectable carcinoma: a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil—an Eastern Cooperative Oncology Group study. J Clin Oncol 1985; 3: 373–378.CrossRefGoogle ScholarPubMed
Hazel, J J, Thirlwell, M P, Huggins, M et al. Multi-Drug chemotherapy with and without radiation for carcinoma of the stomach and pancreas: a prospective randomized trial. J Can Assoc Radiol 1981; 32: 164–165.Google ScholarPubMed
Hammel, P, Hugel, F, van Laethem, J L et al. Effect of Chemoradiotherapy vs chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib: the LAP07 randomized clinical trial. JAMA 2016; 315: 1844–1853.CrossRefGoogle ScholarPubMed
Blakaj, A, Stein, S M, Khan, S A et al. Review and current state of radiation therapy for locally advanced pancreatic adenocarcinoma. J Gastrointest Oncol 2018; 9: 1027–1036.10.21037/jgo.2018.03.07CrossRefGoogle ScholarPubMed
Jaoude, J A, Kouzy, R, Nguyen, N D et al. Radiation therapy for patients with locally advanced pancreatic cancer: evolving techniques and treatment strategies. Curr Prob Cancer 2020. doi: 10.1016/j.currproblcancer.2020.100607.Google Scholar
Shibamoto, Y, Kubota, T, Kishii, K et al. Radiosensitivity of human pancreatic cancer cells in vitro and in vivo, and the effect of a new hypoxic cell sensitizer, doranidazole. Radiother Oncol 2000; 56: 265–270.CrossRefGoogle ScholarPubMed
Shibamoto, Y, Manabe, T, Baba, N et al. High dose, external beam and intraoperative radiotherapy in the treatment of resectable and unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 1990; 19: 605–611.10.1016/0360-3016(90)90486-4CrossRefGoogle ScholarPubMed
Shibamoto, Y, Naruse, A, Fukuma, H et al. Influence of contrast materials on dose calculation in radiotherapy planning using computed tomography for tumors at various anatomical regions: a prospective study. Radiother Oncol 2007; 84: 52–55.CrossRefGoogle ScholarPubMed
Shibamoto, Y, Manabe, T, Ohshio, G et al. High-Dose intraoperative radiotherapy for unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 1996; 34: 57–63.CrossRefGoogle ScholarPubMed
Karasawa, K, Sunamura, M, Okamoto, A et al. Efficacy of novel hypoxic cell sensitiser doranidazole in the treatment of locally advanced pancreatic cancer: long-term results of a placebo-controlled randomised study. Radiother Oncol 2008; 87: 326–330.CrossRefGoogle ScholarPubMed
Shibamoto, Y, Sugie, C, Ito, M et al. The Japanese experiences with hypoxia-targeting pharmacoradiotherapy: from hypoxic cell sensitizers to radiation-activated prodrugs. Expert Opin Pharmacother 2004; 5: 2459–2467.CrossRefGoogle Scholar
Gurka, M K, Collins, S P, Slack, R et al. Stereotactic body radiation therapy with concurrent full-dose gemcitabine for locally advanced pancreatic cancer: a pilot trial demonstrating safety. Radiat Oncol 2013; 8: 44.CrossRefGoogle ScholarPubMed
Herman, J M, Chang, D T, Goodman, K A et al. Phase 2 multi-institutional trial evaluating gemcitabine and stereotactic body radiotherapy for patients with locally advanced unresectable pancreatic adenocarcinoma. Cancer 2015; 121: 1128–1137.CrossRefGoogle ScholarPubMed
Wang, Z, Ren, Z G, Ma, N Y et al. Intensity modulated radiotherapy for locally advanced and metastatic pancreatic cancer: a mono-institutional retrospective analysis. Radiat Oncol 2015; 10: 14.CrossRefGoogle ScholarPubMed
Nakamura, A, Hiraoka, M, Itasaka, S et al. Evaluation of dynamic tumor-tracking intensity-modulated radiotherapy for locally advanced pancreatic cancer. Sci Rep 2018; 8: 17096.CrossRefGoogle ScholarPubMed
Goto, Y, Nakamura, A, Ashida, R et al. Clinical evaluation of intensity-modulated radiotherapy for locally advanced pancreatic cancer. Radiat Oncol 2018; 13: 118.CrossRefGoogle ScholarPubMed
Oh, E S, Kim, T H, Woo, S M et al. Effectiveness and feasibility of concurrent chemoradiotherapy using simultaneous integrated boost-intensity modulated radiotherapy with and without induction chemotherapy for locally advanced pancreatic cancer. Radiat Oncol J 2018; 36: 200–209.CrossRefGoogle ScholarPubMed
Huguet, F, Hajj, C, Winston, C B et al. Chemotherapy and intensity-modulated radiation therapy for locally advanced pancreatic cancer achieves a high rate of R0 resection. Acta Oncol 2017; 56: 384–390.CrossRefGoogle ScholarPubMed
De Felice, F, Benevento, I, Bulzonetti, N et al. Hypofractionated intensity-modulated radiotherapy in locally advanced unresectable pancreatic cancer: a pilot study. Curr Prob Cancer 2019; 43: 495–503.CrossRefGoogle ScholarPubMed
Takaoka, T, Shibamoto, Y, Murai, T et al. Helical tomotherapy for chemo-refractory multiple liver metastases. Cancer Med 2019; 8: 7594–7602.CrossRefGoogle ScholarPubMed