Prognostic Factors for Survival and Resection in Patients with Initial Nonresectable Locally Advanced Pancreatic Cancer Treated with Chemoradiotherapy

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

BACKGROUND AND PURPOSE: Controversies regarding the optimal therapy for patients with locally advanced pancreatic cancer (LAPC) exist. Although the prognosis as a whole remains dismal, subgroups are known to benefit from intensive therapy, including chemoradiotherapy (CRT). We describe the results in 178 patients treated from 2001 to 2010 and have developed a prognostic model for both survival and the possibility of a subsequent resection in these patients. METHODS AND MATERIALS: From 2001 until 2010, 178 consecutive patients with LAPC were treated and included in the present study, with CRT consisting of 50 Gy in 27 fractions combined with tegafur-uracil(UFT)/folinic acid(FA). RESULTS: The median survival from diagnosis was 11.5 months. Adverse events of Grade 3 or above were seen in 36% of the patients. Ninety-three percent of the patients completed all fractions. A Cox regression model for survival demonstrated resection (hazard ratio [HR] 0.12; 95% confidence interval [CI], 0.1-0.3) and pre-CRT gemcitabine-based therapy (HR 0.57; 95% CI, 0.4-0.9) as being associated with a favorable outcome, increasing gross tumor volume (HR 1.14; 95% CI, 1.0-1.3) was associated with shorter survival. A logistic regression model showed Stage III disease (odds ratio [OR] 0.16; 95% CI, 0.0-1.1) and abnormal hemoglobin (OR 0.26; 95% CI, 0.0-1.2) as being associated with lower odds of resection. CONCLUSION: This study confirms the favorable prognosis for patients receiving gemcitabine therapy before CRT and the poor prognosis associated with increasing tumor volume. In addition, CRT in patients with abnormal hemoglobin and Stage III disease rarely induced tumor shrinkage allowing subsequent resection.
OriginalsprogEngelsk
TidsskriftInternational Journal of Radiation Oncology, Biology, Physics
Vol/bind83
Udgave nummer3
Sider (fra-til)909-15
Antal sider16
ISSN0360-3016
DOI
StatusUdgivet - 2012

Fingeraftryk

Pancreatic Neoplasms
cancer
confidence
gemcitabine
Confidence Intervals
prognosis
therapy
intervals
hazards
tumors
hemoglobin
Tumor Burden
regression analysis
Logistic Models
Odds Ratio
Tegafur
uracil
Uracil
logistics
subgroups

Citer dette

@article{82acabb3a2ea4d9d8684812793a7b9e1,
title = "Prognostic Factors for Survival and Resection in Patients with Initial Nonresectable Locally Advanced Pancreatic Cancer Treated with Chemoradiotherapy",
abstract = "BACKGROUND AND PURPOSE: Controversies regarding the optimal therapy for patients with locally advanced pancreatic cancer (LAPC) exist. Although the prognosis as a whole remains dismal, subgroups are known to benefit from intensive therapy, including chemoradiotherapy (CRT). We describe the results in 178 patients treated from 2001 to 2010 and have developed a prognostic model for both survival and the possibility of a subsequent resection in these patients. METHODS AND MATERIALS: From 2001 until 2010, 178 consecutive patients with LAPC were treated and included in the present study, with CRT consisting of 50 Gy in 27 fractions combined with tegafur-uracil(UFT)/folinic acid(FA). RESULTS: The median survival from diagnosis was 11.5 months. Adverse events of Grade 3 or above were seen in 36{\%} of the patients. Ninety-three percent of the patients completed all fractions. A Cox regression model for survival demonstrated resection (hazard ratio [HR] 0.12; 95{\%} confidence interval [CI], 0.1-0.3) and pre-CRT gemcitabine-based therapy (HR 0.57; 95{\%} CI, 0.4-0.9) as being associated with a favorable outcome, increasing gross tumor volume (HR 1.14; 95{\%} CI, 1.0-1.3) was associated with shorter survival. A logistic regression model showed Stage III disease (odds ratio [OR] 0.16; 95{\%} CI, 0.0-1.1) and abnormal hemoglobin (OR 0.26; 95{\%} CI, 0.0-1.2) as being associated with lower odds of resection. CONCLUSION: This study confirms the favorable prognosis for patients receiving gemcitabine therapy before CRT and the poor prognosis associated with increasing tumor volume. In addition, CRT in patients with abnormal hemoglobin and Stage III disease rarely induced tumor shrinkage allowing subsequent resection.",
author = "Bjerregaard, {Jon K} and Mortensen, {Michael B} and Jensen, {Helle A} and Morten Nielsen and Per Pfeiffer",
note = "Copyright {\circledC} 2011 Elsevier Inc. All rights reserved.",
year = "2012",
doi = "10.1016/j.ijrobp.2011.09.008",
language = "English",
volume = "83",
pages = "909--15",
journal = "International Journal of Radiation Oncology, Biology, Physics",
issn = "0360-3016",
publisher = "Elsevier",
number = "3",

}

TY - JOUR

T1 - Prognostic Factors for Survival and Resection in Patients with Initial Nonresectable Locally Advanced Pancreatic Cancer Treated with Chemoradiotherapy

AU - Bjerregaard, Jon K

AU - Mortensen, Michael B

AU - Jensen, Helle A

AU - Nielsen, Morten

AU - Pfeiffer, Per

N1 - Copyright © 2011 Elsevier Inc. All rights reserved.

PY - 2012

Y1 - 2012

N2 - BACKGROUND AND PURPOSE: Controversies regarding the optimal therapy for patients with locally advanced pancreatic cancer (LAPC) exist. Although the prognosis as a whole remains dismal, subgroups are known to benefit from intensive therapy, including chemoradiotherapy (CRT). We describe the results in 178 patients treated from 2001 to 2010 and have developed a prognostic model for both survival and the possibility of a subsequent resection in these patients. METHODS AND MATERIALS: From 2001 until 2010, 178 consecutive patients with LAPC were treated and included in the present study, with CRT consisting of 50 Gy in 27 fractions combined with tegafur-uracil(UFT)/folinic acid(FA). RESULTS: The median survival from diagnosis was 11.5 months. Adverse events of Grade 3 or above were seen in 36% of the patients. Ninety-three percent of the patients completed all fractions. A Cox regression model for survival demonstrated resection (hazard ratio [HR] 0.12; 95% confidence interval [CI], 0.1-0.3) and pre-CRT gemcitabine-based therapy (HR 0.57; 95% CI, 0.4-0.9) as being associated with a favorable outcome, increasing gross tumor volume (HR 1.14; 95% CI, 1.0-1.3) was associated with shorter survival. A logistic regression model showed Stage III disease (odds ratio [OR] 0.16; 95% CI, 0.0-1.1) and abnormal hemoglobin (OR 0.26; 95% CI, 0.0-1.2) as being associated with lower odds of resection. CONCLUSION: This study confirms the favorable prognosis for patients receiving gemcitabine therapy before CRT and the poor prognosis associated with increasing tumor volume. In addition, CRT in patients with abnormal hemoglobin and Stage III disease rarely induced tumor shrinkage allowing subsequent resection.

AB - BACKGROUND AND PURPOSE: Controversies regarding the optimal therapy for patients with locally advanced pancreatic cancer (LAPC) exist. Although the prognosis as a whole remains dismal, subgroups are known to benefit from intensive therapy, including chemoradiotherapy (CRT). We describe the results in 178 patients treated from 2001 to 2010 and have developed a prognostic model for both survival and the possibility of a subsequent resection in these patients. METHODS AND MATERIALS: From 2001 until 2010, 178 consecutive patients with LAPC were treated and included in the present study, with CRT consisting of 50 Gy in 27 fractions combined with tegafur-uracil(UFT)/folinic acid(FA). RESULTS: The median survival from diagnosis was 11.5 months. Adverse events of Grade 3 or above were seen in 36% of the patients. Ninety-three percent of the patients completed all fractions. A Cox regression model for survival demonstrated resection (hazard ratio [HR] 0.12; 95% confidence interval [CI], 0.1-0.3) and pre-CRT gemcitabine-based therapy (HR 0.57; 95% CI, 0.4-0.9) as being associated with a favorable outcome, increasing gross tumor volume (HR 1.14; 95% CI, 1.0-1.3) was associated with shorter survival. A logistic regression model showed Stage III disease (odds ratio [OR] 0.16; 95% CI, 0.0-1.1) and abnormal hemoglobin (OR 0.26; 95% CI, 0.0-1.2) as being associated with lower odds of resection. CONCLUSION: This study confirms the favorable prognosis for patients receiving gemcitabine therapy before CRT and the poor prognosis associated with increasing tumor volume. In addition, CRT in patients with abnormal hemoglobin and Stage III disease rarely induced tumor shrinkage allowing subsequent resection.

U2 - 10.1016/j.ijrobp.2011.09.008

DO - 10.1016/j.ijrobp.2011.09.008

M3 - Journal article

VL - 83

SP - 909

EP - 915

JO - International Journal of Radiation Oncology, Biology, Physics

JF - International Journal of Radiation Oncology, Biology, Physics

SN - 0360-3016

IS - 3

ER -