Concurrent Chemoradiotherapy Versus Chemotherapy Alone for Unresectable Locally Advanced Pancreatic Cancer: A Retrospective Cohort Study
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Purpose The optimal treatment strategy for locally advanced pancreatic cancer (LAPC), particularly the role of concurrent chemoradiotherapy (CCRT), remains debatable. We compared the clinical outcomes of CCRT and palliative chemotherapy alone (CA) in patients with unresectable LAPC. Materials and Methods Patients with LAPC who were consecutively treated between 2003 and 2010 were included. Resectability was evaluated according to National Comprehensive Cancer Network ver. 1.2012. The clinical outcomes for each treatment group (CCRT vs. CA) were evaluated retrospectively. Results Sixty-three patients (58.9%) and 44 patients (41.1%) were treated with CCRT and CA, respectively. The CCRT cohort included patients who were treated with CCRT with or without chemotherapy backbone (CCRT alone, induction chemotherapy-CCRT, CCRT-maintenance chemotherapy, and induction-CCRT-maintenance chemotherapy). Median progression-free survival (PFS) and overall survival (OS) of all patients were 7.2 months and 13.1 months. PFS of the CCRT and CA groups was 9.0 months and 4.4 months, respectively (p=0.020). OS of the CCRT and CA groups was 15.4 months and 9.3 months, respectively (p=0.011). In multivariate analysis, the adjusted hazard ratio of CCRT was 0.536 (p=0.003) for OS and 0.667 (p=0.078) for PFS. Although the pattern of failure was similar in the CCRT and CA groups, the times to both local and distant failure were significantly longer in the CCRT group. Conclusion In patients with unresectable LAPC, those who underwent CCRT during their entire treatment courses had longer OS than patients treated with chemotherapy alone.
Abstract
Purpose The optimal treatment strategy for locally advanced pancreatic cancer (LAPC), particularly the role of concurrent chemoradiotherapy (CCRT), remains debatable. We compared the clinical outcomes of CCRT and palliative chemotherapy alone (CA) in patients with unresectable LAPC. Materials and Methods Patients with LAPC who were consecutively treated between 2003 and 2010 were included. Resectability was evaluated according to National Comprehensive Cancer Network ver. 1.2012. The clinical outcomes for each treatment group (CCRT vs. CA) were evaluated retrospectively. Results Sixty-three patients (58.9%) and 44 patients (41.1%) were treated with CCRT and CA, respectively. The CCRT cohort included patients who were treated with CCRT with or without chemotherapy backbone (CCRT alone, induction chemotherapy-CCRT, CCRT-maintenance chemotherapy, and induction-CCRT-maintenance chemotherapy). Median progression-free survival (PFS) and overall survival (OS) of all patients were 7.2 months and 13.1 months. PFS of the CCRT and CA groups was 9.0 months and 4.4 months, respectively (p=0.020). OS of the CCRT and CA groups was 15.4 months and 9.3 months, respectively (p=0.011). In multivariate analysis, the adjusted hazard ratio of CCRT was 0.536 (p=0.003) for OS and 0.667 (p=0.078) for PFS. Although the pattern of failure was similar in the CCRT and CA groups, the times to both local and distant failure were significantly longer in the CCRT group. Conclusion In patients with unresectable LAPC, those who underwent CCRT during their entire treatment courses had longer OS than patients treated with chemotherapy alone.
참고문헌 (20)
- Kris MG, "Clinical cancer advances 2010 : annual report on progress against cancer from the American Society of Clinical Oncology", J Clin Oncol, 28, pp.5327~5347 (2010)
- Mayahara H, "Salvage chemoradiotherapy after primary chemotherapy for locally advanced pancreatic cancer : a single-institution retrospective analysis", BMC Cancer, 12, pp.609~ (2012)
- Moertel CG, "Therapy of locally unresectable pancreatic carcinoma : a randomized comparison of high dose(6000 rads)radiation alone, moderate dose radiation(4000 rads + 5-fluorou-racil), and high dose radiation + 5-fluorouracil : The Gastrointestinal Tumor Study Group", Cancer, 48, pp.1705~1710 (1981)
- Hariharan D, "Analysis of mortality rates for pancreatic cancer across the world", HPB(Oxford), 10, pp.58~62 (2008)
- Treatment of locally unresectable carcinoma of the pancreas : comparison of combined-modality therapy(chemotherapy plus radiotherapy)to chemotherapy alone, "Gastrointestinal Tumor Study Group", J Natl Cancer Inst, 80, pp.751~755 (1988)
- Cohen SJ, "A randomized phase III study of radiotherapy alone or with 5-fluorouracil and mitomycin-C in patients with locally advanced adenocarcinoma of the pancreas : Eastern Cooperative Oncology Group study E8282", Int J Radiat Oncol Biol Phys, 62, pp.1345~1350 (2005)
- Chauffert B, "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, 2008, pp.19, 1592~1599
- Loehrer PJ Sr, "Gemcitabine alone versus gemcitabine plus radiother-apy in patients with locally advanced pancreatic cancer : an Eastern Cooperative Oncology Group trial", J Clin Oncol, 29, pp.4105~4112 (2011)
- Huguet F, "Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies", J Clin Oncol, 25, pp.326~331 (2007)
- Bidard FC, "Circulating tumor cells in locally advanced pancreatic adenocarcinoma : the ancillary CirCe 07 study to the LAP 07 trial", Ann Oncol, 24, pp.2057~2061 (2013)
- Wilkowski R, "Chemoradiotherapy with concurrent gemcitabine and cisplatin with or without sequential chemotherapy with gemcitabine", cisplatin vs chemoradiotherapy with concurrent 5-fluorouracil in patients with locally advanced pancreatic cancer-a multi-centre randomised phase II study, 2009, pp.101, 1853~1859
- Zhu CP, "Gemcitabine in the chemoradiotherapy for locally advanced pancreatic cancer : a meta-analysis", Radiother Oncol, 99, pp.108~113 (2011)
- Li CP, "Concurrent chemoradiotherapy treatment of locally advanced pancreatic cancer : gemcitabine versus 5-fluorouracil, a randomized controlled study", Int J Radiat Oncol Biol Phys, 57, pp.98~104 (2003)
- Mukherjee S, "Gemcitabine-based or capecitabine-based chemoradiotherapy for locally advanced pancreatic cancer(SCALOP) : a multicentre, randomised, phase 2 trial", Lancet Oncol, 14, pp.317~326 (2013)
- National Comprehensive Cancer Network, "NCCN guidelines for treatment of cancer by site" (2014), National Comprehensive Cancer Network
- Crane CH, "Is the therapeutic index better with gemcitabine-based chemoradiation than with 5-fluorouracil-based chemoradiation in locally advanced pancreatic cancer?", Int J Radiat Oncol Biol Phys, 52, pp.1293~1302 (2002)
- Klaassen DJ, "Treatment of locally unresectable cancer of the stomach and pancreas : a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil : an Eastern Cooperative Oncology Group study", J Clin Oncol, 3, pp.373~378 (1985)
- Krishnan S, "Induction chemotherapy selects patients with locally advanced, unresectable pancreatic cancer for optimal benefit from consolidative chemoradiation therapy", Cancer, 110, pp.47~55 (2007)
- Ajani JA, "Preoperative induction of CPT-11 and cisplatin chemotherapy followed by chemoradiotherapy in patients with locoregional carcinoma of the esophagus or gastroesophageal junction", Cancer, 100, pp.2347~2354 (2004)
- Lloyd S, "A comparison of three treatment strategies for locally advanced and borderline resectable pancreatic cancer", J Gastrointest Oncol, 4, pp.123~130 (2013)