Effectiveness and Prognostic Factors of Precise Radiotherapy for Pancreatic Cancer

  Objective  To analyze the effectiveness and prognostic factors of precise radiotherapy for pancreatic cancer.

  Methods  Totally 102 patients with pancreatic cancer received precise radiotherapy in our hospital between January 2003 and June 2012, among whom 54 received radical radiotherapy and 48 underwent adjuvant radiotherapy. Three-dimensional conformal radiotherapy (3D-CRT) was performed in 16 cases and intensity-modulated radiotherapy (IMRT) in 86 cases, with a median radiotherapy dose of 50 Gy (1.8~2.2 Gy/fraction). Concurrent capecitabine chemotherapy was carried out in 13 cases.

  Results  The average overall survival time (OS) and the average time to progress-free survival (PFS) was (14±1.2) months and (9±1.1) months, respectively. The 1-, 2-, and 5-year survival rates were 63.3%, 22.6%, and 10%, respectively. Grade 3 gastrointestinal toxicity occurred in 5 cases. No grade 3 or 4 hematologic toxicity and grade 4 gastrointestinal toxicity was observed. Univariate analysis showed that weight loss of > 5 kg before treatment (P < 0.0001), T stage (P=0.011), TNM stage (P=0.007), and surgical excision (P=0.001) were significantly associated with OS and PFS. Multivariate analysis showed that surgical excision was a prognostic factor for OS (χ²=5.416, P=0.020).

  Conclusions  The precise radiotherapy including 3D-CRT and IMRT can be tolerated with fewer grade 3 and 4 toxicities in pancreatic cancer patients after radical radiotherapy and adjuvant radiotherapy, thus make it feasible for the concurrent chemotherapy and the increase of radiotherapy dose. Surgical excision can improve the OS of pancreatic cancer patients.