Comparison of proton beam radiotherapy and hyper-fractionated accelerated chemoradiotherapy for locally advanced pancreatic cancer

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2017-09, Vol.17 (5), p.833-838
• Main Authors: Maemura, Kosei, Mataki, Yuko, Kurahara, Hiroshi, Kawasaki, Yota, Iino, Satoshi, Sakoda, Masahiko, Ueno, Shinichi, Arimura, Takeshi, Higashi, Ryutaro, Yoshiura, Takashi, Shinchi, Hiroyuki, Natsugoe, Shoji
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antigens; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - therapeutic use; Cancer therapies; Chemoradiotherapy; Chemotherapy; Clinical outcomes; Disease control; Female; Gemcitabine; Humans; Hyper fractionated radiotherapy; Male; Medical prognosis; Middle Aged; NMR; Nuclear magnetic resonance; Pancreatic cancer; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - radiotherapy; Patients; Proton beam radiotherapy; Proton Therapy; Quality of life; Radiation therapy; Studies; Survival; Systematic review; Treatment Outcome; Tumors; Ulcers; Unresectable cancer
• ISSN: 1424-3903; 1424-3911
• DOI: 10.1016/j.pan.2017.07.191

We compared the clinical outcomes of proton beam radiotherapy (PBRT) and those of conventional chemoradiotherapy via hyper-fractionated acceleration radiotherapy (HART) after induction chemotherapy in patients with locally advanced pancreatic cancer (LAPC). Twenty-five consecutive patients with LAPC received induction chemotherapy comprising gemcitabine and S-1 before radiotherapy. Of these, 15 and 10 were enrolled in the HART and PBRT groups, respectively. Moderate hematological toxicities were observed only in the HART group, whereas two patients in the PBRT group developed duodenal ulcers. All patients underwent scheduled radiotherapy, with overall disease control rates of 93% and 80% in the HART and PBRT groups, respectively. Local progression was observed in 60% and 40% of patients in the HART and PBRT groups, respectively. However, there was no statistical significance between the two groups regarding the median time to progression (15.4 months in both) and the median overall survival (23.4 v.s. 22.3 months). PBRT was feasible and tolerable, and scheduled protocols could be completed with careful attention to gastrointestinal ulcers. Despite the lower incidence of local recurrence, PBRT did not yield obvious progression control and survival benefits relative to conventional chemoradiotherapy.