Induction Gemcitabine Plus Concurrent Gemcitabine and Radiotherapy for Locally Advanced Unresectable or Resected Pancreatic Cancer |
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| Affiliation: | 1. Department of Radiation Oncology, University Health Network, Princess Margaret Cancer Centre and The University of Toronto, Toronto, Ontario, Canada;2. Department of Surgical Oncology, University Health Network, Princess Margaret Cancer Centre and The University of Toronto, Toronto, Ontario, Canada;3. Department of Medical Oncology, University Health Network, Princess Margaret Cancer Centre and The University of Toronto, Toronto, Ontario, Canada;4. Department of Biostatistics, University Health Network, Princess Margaret Cancer Centre and The University of Toronto, Toronto, Ontario, Canada;1. Center for Prostate Cancer, National Cancer Center, Goyang, Korea;2. Department of Epidemiology and Health Promotion, Yonsei University Graduate School of Public Health, Seoul, Korea;3. Cancer Biostatistics Branch, National Cancer Center, Goyang, Korea;4. Department of Urology, Wonkwang University School of Medicine, Iksan, Korea;5. Department of Urology, National Police Hospital, Seoul, Korea;6. Center for Diagnostic Oncology, National Cancer Center, Goyang, Korea;7. Center for Cancer Prevention and Detection, National Cancer Center, Goyang, Korea;1. Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea;2. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea;1. Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada;2. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland;3. Center for Cancer Biostatistics, Biostatistics Unit, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan;4. Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan;5. Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, Ohio;7. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada;1. Department of Internal Medicine, Gachon University of Medicine and Science, Incheon, Korea;2. Department of Surgery, Gachon University of Medicine and Science, Incheon, Korea |
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| Abstract: | AimsTo determine the efficacy of induction gemcitabine followed by biweekly gemcitabine concurrent with radiotherapy for locally advanced pancreatic cancer.Materials and methodsBetween March 2001 and August 2009, 90 patients with unresectable (78) or resected (12) pancreatic cancer were treated with a standard treatment policy of induction gemcitabine (seven doses of weekly gemcitabine at 1000 mg/m2) followed by concurrent radiotherapy (52.5 Gy) and biweekly gemcitabine (40 mg/m2).ResultsAfter induction gemcitabine, 17.8% of patients did not proceed to chemoradiotherapy, due to either disease progression, performance status deterioration or gemcitabine toxicity. Of the patients who received chemoradiotherapy, 68.9% completed the course of 52.5 Gy, whereas 79.7% received more than 45 Gy. Chemoradiotherapy was stopped early due to treatment toxicity in 22.9% of patients. On intention to treat analysis, the median overall survival was 12.7 months in the locally advanced group and 18.2 months in the resected group. On multivariate analysis for the unresectable patients, a larger gross tumour volume was a significant poor prognostic factor for overall survival and local progression-free survival.ConclusionThis large series confirms, in a standard practice setting, similar efficacy and tolerability of treatment as previously reported in our phase I–II study. The benefit to patients with a gross tumour volume >48 cm3 may be limited. |
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| Keywords: | Chemoradiotherapy induction gemcitabine pancreatic cancer |
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