BACKGROUND: There is no consensus on
the indication for salvage chemoradiotherapy (CRT) after failure of primary
chemotherapy for locally advanced pancreatic cancer (LAPC). Here we report on
the retrospective analysis of patients who received salvage CRT after primary
chemotherapy for LAPC. The primary objective of this study was to evaluate the
efficacy and safety of salvage CRT after primary chemotherapy for LAPC.
METHODS:
Thirty patients who underwent
salvage CRT, after the failure of primary chemotherapy for LAPC, were retrospectively
enrolled from 2004 to 2011 at the authors' institution. All the patients had
histologically confirmed pancreatic adenocarcinoma.
RESULTS:
Primary chemotherapy was continued
until progression or emergence of unacceptable toxicity. Eventually, 26
patients (87%) discontinued primary chemotherapy because of local tumor
progression, whereas four patients (13%) discontinued chemotherapy because of
interstitial pneumonitis caused by gemcitabine. After a median period of 7.9
months from starting chemotherapy, 30 patients underwent salvage CRT combined
with either S-1 or 5-FU. Toxicities were generally mild and self-limiting.
Median survival time (MST) from the start of salvage CRT was 8.8 months. The 6
month, 1-year and 2-year survival rates from the start of CRT were 77%, 33% and
26%, respectively. Multivariate analysis revealed that a lower pre-CRT serum CA
19--9 level (<= 1000 U/ml; p = 0.009) and a single regimen of primary
chemotherapy (p = 0.004) were independent prognostic factors for survival after
salvage CRT. The MST for the entire patient population from the start of
primary chemotherapy was 17.8 months, with 2- and 3-year overall survival rates
of 39% and 22%, respectively.
CONCLUSIONS:
CRT had moderate anti-tumor activity
and an acceptable toxicity profile in patients with LAPC, even after failure of
gemcitabine-based primary chemotherapy. If there are any signs of failure of
primary chemotherapy without distant metastasis, salvage CRT could be a
treatment of choice as a second-line therapy. Patients with relatively low
serum CA19-9 levels after primary chemotherapy may achieve higher survival
rates after salvage CRT. The strategy of using chemotherapy alone as a primary
treatment for LAPC, followed-by CRT with salvage intent should be further
investigated in prospective clinical trials.Trial registration: 2011--136.
Source: Salvage chemoradiotherapy
after primary chemotherapy for locally advanced pancreatic cancer: a
single-institution retrospective analysis. Mayahara H (hmayahar@ncc.go.jp), Ito Y, Morizane C,
Ueno H, Okusaka T, Kondo S, Murakami N, Morota M, Sumi M, Itami J. BMC Cancer.
2012 Dec 20;12(1):609. [Epub ahead of print]
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