Elsevier

Radiotherapy and Oncology

Volume 136, July 2019, Pages 37-43
Radiotherapy and Oncology

Original Article
Concurrent chemoradiotherapy using proton beams for unresectable locally advanced pancreatic cancer

https://doi.org/10.1016/j.radonc.2019.03.012Get rights and content
Under a Creative Commons license
open access

Highlights

  • We investigated outcome of chemoradiotherapy using proton beams for pancreatic cancer.

  • 2-year overall survival rate was 50.8% with median 25.6 months.

  • 2-year local control rate 78.9% with median more than 36 months.

  • Severe gastrointestinal tract adverse events were not observed.

  • Higher dose delivery to the tumor with proton beams safely lead to longer LC and OS.

Abstract

Background and purpose

We investigated clinical outcomes of proton beam concurrent chemoradiotherapy (CCRT) for unresectable, locally advanced pancreatic cancer (LAPC) patients.

Materials and methods

Records from 42 unresectable LAPC patients (21 male and 21 female, 39–83 years old) with IIB/III clinical staging of 1/41 treated by proton beam CCRT were retrospectively reviewed. Twelve patients received a conventional 50 Gray equivalents (GyE) in 25 fractions protocol and 30 others received a higher dose protocol of 54.0–67.5 GyE in 25–33 fractions. Gemcitabine or S-1 (Tegafur, Gimeracil and Oteracil) was used concurrently. Toxicity, overall survival (OS) and local control (LC) were examined.

Results

Acute adverse events of grades 1, 2, 3 and 4 were found in 4, 15, 17 and 2 patients, respectively. All grade 3 and 4 events were hematologic. Late adverse events of grades 1 and 2 were found in 3 and 2 patients, respectively. No late adverse effects of grade 3 or higher were observed. The 1-year/2-year OS rates from the start of CCRT were 77.8/50.8% with median survival time (MST) of 25.6 months. The 1-year/2-year LC rate from CCRT start was 83.3/78.9% with a median time to local recurrence of more than 36 months. Total irradiation dose was the only significant factor in univariate analyses of OS and LC (p = 0.015 and 0.023, respectively).

Conclusion

Proton beam CCRT lengthened survival periods compared to previous photon CCRT data and higher dose irradiation prolonged LC and OS for unresectable LAPC patients. Proton beam therapy is therefore safe and effective in these cases.

Keywords

Pancreatic cancer
Proton beam therapy
Radiotherapy
Chemotherapy

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