Pancreatic cancer: better survival with proton-beam chemoradiotherapy

  • Radiother Oncol

  • curated by Emily Willingham, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Proton-beam concurrent chemoradiotherapy (CCRT) prolongs OS and local control (LC) vs photon-beam CCRT in patients with unresectable, locally advanced pancreatic cancer.
  • Therapy looks safe and effective for these patients.

Why this matters

  • Proton beams can be more targeted than photon beams, allowing higher doses while sparing gastrointestinal tissues.

Key results

  • All higher-grade adverse events were hematologic, not gastrointestinal, and all were acute.
  • From start of CCRT:
    • 1-year OS: 77.8%;
    • 2-year OS: 50.8%.
  • Median survival: 25.6 months.
  • From start of CCRT:
    • 1-year LC: 83.3%;
    • 2-year LC: 78.9%.
  • Median to local recurrence: >36 months.
  • Total irradiation dose was the relevant factor for both OS (P=.015) and LC (P=.023) outcomes.
  • For comparison, 2-year OS for: 
    • 3D conformal chemoradiotherapy: 2.8%-13%.
    • Modulated radiotherapy: 22%-32.9%.
    • Photon-based CCRT: 11%.

Study design

  • Study of 42 patients aged 39-83 years with stage III (n=41) or IIB (n=1) locally advanced pancreatic cancer.
  • 12 received conventional 50 Gray equivalents (GyE) in 25 fractions; 30 received a higher dose protocol of 54.0-67.5 GyE in 25-33 fractions.
  • Chemotherapy consisted of gemcitabine or S1 (tegafur-gimeracil-oteracil).
  • Funding: Ministry of Education, Science, Sports and Culture of Japan; Japan Agency for Medical Research and Development.

Limitations

  • Retrospective, some variation in pretreatment regimens.

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