Chemoradiotherapy for Locally Advanced Pancreatic Carcinoma in Elderly Patients

Morizane, Chigusa; Okusaka, Takuji; Ito, Yoshiaki; Ueno, Hideki; Ikeda, Masafumi; Takezako, Yoriko; Kagami, Yoshikazu; Ikeda, Hiroshi

doi:10.1159/000086985

Cited by 16 publications

(7 citation statements)

References 49 publications

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“…Our results compare favorably with median OS of 28.1 months for resected patients treated with SBRT and chemotherapy. However, for patients with locally advanced disease, receiving either chemotherapy alone or chemoradiation with EBRT, median OS ranges from 8.6 to 11.4 months which is similar to our reported 11.4 months for patients receiving definitive SBRT ( 21 – 23 ).…”

Section: Discussionsupporting

confidence: 86%

Prognostic Factors for Elderly Patients Treated With Stereotactic Body Radiation Therapy for Pancreatic Adenocarcinoma

et al. 2018

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Introduction: Pancreatic ductal adenocarcinoma (PDAC) commonly presents later in life with a median age at diagnosis of 70 years. Unfortunately, elderly patients are significantly underrepresented in clinical trials. Stereotactic body radiation therapy (SBRT) is a promising treatment modality in this population as it has demonstrated excellent local control with minimal toxicity. We aimed to determine prognostic factors associated with outcomes in elderly patients treated with SBRT.Materials and Methods: Elderly patients older than 70 treated with SBRT for PDAC at our institution, from 2004 to 2014 were included. Our primary endpoints included overall survival (OS) and local-progression-free survival (LPFS). Secondary endpoints included regional-progression-free survival (RPFS), distant-progression-free-survival (DPFS) and radiation toxicity. Endpoints were analyzed with the Kaplan-Meier method. The association of these survival endpoints with risk factors was studied with Cox proportional hazards models.Results: We identified 145 patients with 146 lesions of pancreatic adenocarcinoma with a median age at diagnosis of 79 (range, 70.1–90.3). SBRT was delivered to a median dose of 36 Gy (IQR 24–36). Surgical resection was performed on 33.8% of the total patients. Median follow-up was 12.3 months (IQR 6.0–23.3 months) and the median survival for the entire cohort 14.0 months with a 2-year OS of 27%. Multivariate analysis (MVA) demonstrated surgery [p ≤ 0.0001, HR 0.29 (95% CI, 0.16–0.51)] and post-SBRT CA19-9 [p = 0.009, HR 1.0004 (95% CI, 1.0002–1.0005)] significantly associated with overall survival. Recurrent lesions [p = 0.0069, HR 5.1 (95% CI, 1.56–16.64)] and post-SBRT CA19-9 levels [p = 0.0107, HR 1.0005 (95% CI, 1.0001–1.0008)] were significantly associated with local control on MVA. For the entire cohort, 4.1% experienced acute grade 2+ toxicity, and 2% experienced late grade 2+ toxicity at 2 years.Conclusion: This review demonstrates prognostic factors in elderly patients with PDAC treated with SBRT. We identified surgical resection and post-SBRT CA 19-9 as predictive of overall survival in this population. Additionally, we show low acute and late toxicity following SBRT in elderly patients.

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Section: Discussionsupporting

confidence: 86%

Prognostic Factors for Elderly Patients Treated With Stereotactic Body Radiation Therapy for Pancreatic Adenocarcinoma

et al. 2018

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“…The infusion of 5-FU concurrently with radiation therapy has been extensively evaluated against human pancreatic cancer, and is one of the standard treatment approaches (5,7,8). Other first line treatments involving the use of chemotherapeutic agents alone (as in the case of gemcitabine (5,9)), or in combination with 5-FU (i.e., mitomycin, cisplatin, epirubicin and doxorubicin) have demonstrated some clinical success (9Y11).…”

Section: Introductionmentioning

confidence: 99%

Development of 5-FU and Doxorubicin-Loaded Cationic Liposomes against Human Pancreatic Cancer: Implications for Tumor Vascular Targeting

Kalra

Campbell

2006

Pharm Res

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“…5-FU-based chemoradiotherapy for selected elderly patients with locally advanced pancreatic carcinoma leads to a better survival compared with younger patients. [ 15 ] With careful patient selection, GKSRS combined with S-1 can be an appropriate treatment option for elderly patients with local recurrent pancreatic cancer.…”

Section: Discussionmentioning

confidence: 99%

Successful gamma knife radiosurgery combined with S-1 in an elderly man with local recurrent pancreatic cancer

Wei

Dong²,

Du³

et al. 2017

Medicine

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Rationale:Pancreatic cancer is common in people older than 40 years, and the incidence peaks at the age of 70 years and older. Chemoradiotherapy has been generally considered a high-risk procedure in elderly patients with local recurrent pancreatic cancer. Gamma knife stereotactic radiosurgery has the advantage in protecting the surrounding tissues, and providing short-term effects. It has been successfully used in patients with brain metastases.The efficacy of GKSRS in other malignancies has barely been studied.S-1 is one of the key drug against metastatic and local advanced pancreatic cancer. The combination of GKSRS and S-1 in local recurrent pancreatic cancer has hardly been reported.Patient concerns:We present a rare case of a 76-year-old man with pancreatic cancer. He complained of recurrent abdominal pain and chronic pain in the right shoulder for more than 3 years.Diagnoses:After several examinations, the diagnosis was carcinoma of the pancreas.Interventions:A resection of the pancreatic neoplasm was performed on June 21, 2011; he did not receive adjuvant chemotherapy. In April 2014, postoperative recurrence was confirmed in the head of the pancreas. The patient received gamma knife stereotactic radiosurgery (GKSRS) combined with S-1 treatment.Outcomes:The patient showed complete response after 2 months. He has achieved an overall survival of 76 months with a very good performance status.Lessons:GKSRS applied to other malignancies has rarely been reported. S-1 is the key drug for adjuvant chemotherapy in resected pancreatic cancer. There are a few studies on this combination in local recurrent pancreatic cancer. GKSRS combined with S-1 seems to be a good option in improving efficacy and prolonging life in elderly patients with locally recurrent pancreatic cancer.

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Chemoradiotherapy for Locally Advanced Pancreatic Carcinoma in Elderly Patients

Cited by 16 publications

References 49 publications

Prognostic Factors for Elderly Patients Treated With Stereotactic Body Radiation Therapy for Pancreatic Adenocarcinoma

Prognostic Factors for Elderly Patients Treated With Stereotactic Body Radiation Therapy for Pancreatic Adenocarcinoma

Development of 5-FU and Doxorubicin-Loaded Cationic Liposomes against Human Pancreatic Cancer: Implications for Tumor Vascular Targeting

Successful gamma knife radiosurgery combined with S-1 in an elderly man with local recurrent pancreatic cancer

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