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Survival impact on triple-modal strategy comprising hyperthermia, external radiation, and chemotherapy for unresectable locally advanced (UR-LA) pancreatic ductal adenocarcinoma
- Source :
- Surgical oncology. 37
- Publication Year :
- 2020
-
Abstract
- Background Present treatment strategy for unresectable locally advanced (UR-LA) pancreatic ductal adenocarcinoma (PDAC) patients is controversial. Hence, a triple-modal therapy, which is a multidisciplinary strategy, was designed for patients with UR-LA PDAC by adding hyperthermia to conventional chemoradiotherapy at our institution. In this study we aimed to evaluate the effectiveness of this strategy. Methods Data of 21 UR-LA PDAC patients who underwent the triple-modal treatment were retrospectively analyzed for evaluating the safety and oncological effect of the treatment. The treatment schedule included, five concurrent infusions of gemcitabine (800 mg/m2) followed by hyperthermia (1 h) and X-ray (2 Gy) or proton beam radiation (2.7 Gy) on days 1, 8, 15, 29, and 36. Additional radiotherapies applied a total dose of 50 Gy/25 fr for X-ray radiation or 67.5 Gy/25 fr for proton beam radiation. Results Median overall survival (OS) was 23.6 months. Conversion surgery was performed in 5 patients (23.8%), and a R0 margin could be achieved in 4 of them; however, their median OS (16.3 months) tended to be shorter than that of the patients who did not undergo resection (23.6 months, p = 0.562). Further, the median OS of patients who underwent proton beam radiation (28.0 months) was significantly longer than that of patients who underwent X-ray radiation (13.9 months, p = 0.045). Most adverse events were manageable, except for one grade 3 gastric ulcer. The median tumor size and marker reduction rates were −17% and −91%, respectively. The tumor responses were partial response, stable disease, and progressive disease in 3, 15, and 3 patients, respectively. Conclusion Triple-modal strategy, especially when combined with proton beam radiation, is feasible and results in favorable survival outcomes in patients with UR-LA PDAC.
- Subjects :
- Hyperthermia
Adult
Male
medicine.medical_specialty
medicine.medical_treatment
03 medical and health sciences
0302 clinical medicine
Stable Disease
Pancreatic cancer
medicine
Humans
Adverse effect
Aged
Retrospective Studies
Chemotherapy
business.industry
Chemoradiotherapy
Hyperthermia, Induced
Middle Aged
medicine.disease
Combined Modality Therapy
Gemcitabine
Pancreatic Neoplasms
Survival Rate
Oncology
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
Surgery
Female
Radiology
business
Progressive disease
medicine.drug
Carcinoma, Pancreatic Ductal
Subjects
Details
- ISSN :
- 18793320
- Volume :
- 37
- Database :
- OpenAIRE
- Journal :
- Surgical oncology
- Accession number :
- edsair.doi.dedup.....12efc980164102a50a0087d8fbe90bc9