P-181 - Outcome Analysis of Upfront Definitive Chemoradiation for Unresectable Pancreatic Adenocarcinoma: A Single Center Experience for over 25 years

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Anti-Cancer Agents & Biologic Therapy
Pancreatic Cancer
Surgery and/or Radiotherapy of Cancer
Presenter H.K. Koh
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors H.K. Koh1, E.K. Chie1, K. Kim1, J.-. Jang1, S.-. Kim1, S.-. Han1, D.-. Oh1, S.-. Im1, T.Y. Kim2, Y.-. Gang3, S.W. Ha1
  • 1Konkuk University Medical Center, Seoul/KR
  • 2Seoul National University Cancer Hospital, Seoul/KR
  • 3Seoul National University Hospital, Seoul/KR

Abstract

Introduction

The survival outcome of unresectable pancreatic cancer is dismal and the optimal treatment regimen has not been established. Among various treatment strategies, the outcome of definitive chemoradiotherapy (CCRT) without neoadjuvant chemotherapy conducted at single institution was analyzed in the current study.

Methods

From January 1987 to November 2013, consecutive one-hundred fifty patients received definitive CCRT for unresectable pancreatic adenocarcinoma. Eighty four patients undergoing chemoradiation as initial treatment were included for analysis. During CCRT, chemotherapy regimens were 2 cycles of 5-fluorouracil (5-FU) 500 mg/m2 body surface area given in i.v. bolus on D1-3 for 60 patients, one cycle of identically scheduled 5-FU in 7 patients, gemcitabine 300 mg/m2 infused over 30–60 minutes weekly in 13 patients, gemcitabine 40mg/m2 infused twice weekly in one patient and oral dose of 800 mg/m2 twice daily capecitabine in 3 patients. Thirty-three patients underwent adjuvant chemotherapy. The median follow-up duration was 10.2 months (range 1.3 -165.3).

Results

The median age was 59.3 years old (range 32.6 – 78.4). The male to female radio was 1.7:1 (N = 53:31). Eastern Cooperative Oncology Group (ECOG) performance status was 0-1 in 63 patients (75%) and 2-3 in 21 patients (25%). The clinical stage by American Joint Committee on Cancer (AJCC) 7th edition was II in 20 patients (23.8%) and III in 64 patients (76.2%). Thirty-two patients (38.1%) had clinically diagnosed node positive disease. The median radiation dose was 40.0 Gy (range, 40.0 – 56.0). The mean radiation dose was escalated during treatment period (40.0 Gy vs 45.7 Gy vs 54.7 Gy, before 2000 vs 2000 to 2010 vs after 2010, respectively, P < 0.001). The median overall survival (OS) was 10.2 months (95% CI: 9.159 – 11.241). The median OS with treatment period was 9.2 months before 2000, 10.3 months between 2000 and 2010, and 13.5 months after 2010 (P = 0.502). In univariate analysis, radiation dose ≥ 50.0 Gy showed a trend toward better survival. The median OS for patients with radiation dose ≥ 50.0 Gy was 13.5 months versus 9.2 months for patients with radiation dose < 50 Gy (P = 0.079). Age, gender, performance status, clinical stage, nodal stage and chemotherapy regimen during CCRT were not significant variables for OS. In multivariate analysis, radiation dose ≥ 50.0 Gy was a marginally significant prognosticator (P = 0.082). During CCRT, there were 41 cases (48.8%) of grade II and one case (1.2%) of grade III gastrointestinal toxicity, 25 cases (29.8%) of grade II, 4 cases (4.8%) of grade III, and one case (1.2%) of grade IV hematologic toxicity according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.

Conclusion

Definitive CCRT for unresectable pancreatic adenocarcinoma was safe and feasible even for patients with limited performance status. Radiation dose ≥ 50.0 Gy could be beneficial. Radiation dose escalation effect and optimal radiation dose should be confirmed through large volume study.