Prognostic implication of intraoperative radiotherapy for unresectable pancreatic cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 346-346
Author(s):  
T. Fujii ◽  
S. Nagai ◽  
Y. Kodera ◽  
M. Kanda ◽  
T. T. Sahin ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Liver Metastasis ◽  
Peritoneal Metastasis ◽  
Locally Advanced ◽  
Intraoperative Radiotherapy ◽  
Disease Spread ◽  
Unresectable Pancreatic Cancer ◽  
Peritoneal Disease

346 Background: There is no established treatment strategy for unresectable pancreatic cancer, and the prognostic effect of intraoperative radiotherapy (IORT) is considered to be limited. Methods: We reviewed 614 surgical cases of pancreatic cancer and selected 198 cases that did not undergo pancreatectomy because of distant metastasis or locally advanced disease, at the Department of Surgery II, between July 1981 and June 2009. Liver metastasis was observed in 70 patients and peritoneal metastasis in 44. Treatment for those who were feasible consisted of IORT and/or postoperative chemotherapy. Overall survival and prognostic factors were evaluated for all patients and for each pattern of disease spread. Results: IORT was performed in 120 patients (61%), and chemotherapy was indicated in 80 (40%). Overall survival in the non-treatment group was significantly inferior to that for IORT alone and IORT plus gemcitabine (GEM)-based chemotherapy (median survival time: 3.2 months vs. 6.1 and 7.9 months; P = 0.0001 and <0.0001, respectively). After multivariate analysis, IORT and GEM-based chemotherapy were identified as independent prognostic factors [hazard ratio (HR) = 0.51, P < 0.001; HR = 0.43, P < 0.001]. IORT was an independent prognostic determinant for patients with peritoneal metastasis (HR = 0.24, P = 0.011), whereas it was not for those with liver metastasis (HR = 0.78, P = 0.381). Conclusions: The prognostic value of IORT is most prominent in the peritoneal disease. IORT followed by GEM-based chemotherapy is possibly one of the most recommended treatment strategies in unresectable pancreatic cancer. No significant financial relationships to disclose.

scholarly journals Stereotactic body radiotherapy for locally-advanced unresectable pancreatic cancer—patterns of care and overall survival

2017 ◽  
Vol 8 (5) ◽  
pp. 766-777 ◽  
Author(s):  
Michael J. Dohopolski ◽  
Scott M. Glaser ◽  
John A. Vargo ◽  
Goundappa K. Balasubramani ◽  
Sushil Beriwal
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Stereotactic Body Radiotherapy ◽  
Locally Advanced ◽  
Patterns Of Care ◽  
Unresectable Pancreatic Cancer

Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as prognostic factors for locally advanced pancreatic cancer patients.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 326-326
Author(s):  
Byung Min Lee ◽  
Seung Yeun Chung ◽  
Jee Suk Chang ◽  
Kyong Joo Lee ◽  
Si Young Song ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Cancer Patients ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Locally Advanced Pancreatic Cancer ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Pre Treatment

326 Background: It is well known that locally advanced pancreatic cancer patients have a poor prognosis. Recently, hematologic markers showing systemic inflammatory status such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have aroused much attention due to its potential to predict patient survival. In this study, we investigated whether pre-treatment NLR and PLR independently and in combination would be significant prognostic factors for survival in locally advanced pancreatic cancer patients. Methods: A total of 497 locally advanced (borderline resectable and unresectable) pancreatic cancer patients who received neoadjuvant or definitive chemoradiotherapy (CCRT) between January 2005 and December 2015 were included in this study. NLR and PLR prior to the start of treatment within 2 weeks were defined as pre-treatment NLR and PLR. We divided the patients with the median values of pre-treatment NLR and PLR; NLR < 2.44 group (n = 248), NLR ≥ 2.44 group (n = 249), PLR < 149 group (n = 248) and PLR ≥ 149 (n = 249) group. Overall survival (OS) and progression-free survival (PFS) were compared between each group for NLR and PLR. Results: Median overall survival was 15.7 months (range, 2.3-128.5 months). For NLR, the OS, PFS rates were significantly lower in the NLR ≥ 2.44 group, with 1-year OS rates of 67.9% and 61.5% (p = 0.003) and 1-year PFS rates of 38.1% and 32.4% (p = 0.003), for NLR < 2.44 and ≥ 2.44 group, respectively. The PLR ≥ 149 group also showed significantly poorer OS and PFS than PLR < 149 group. The 1-year OS rates were 68.1% and 61.3% (p = 0.029) and 1-year PFS rates were 37.9% and 32.5% (p = 0.027), for PLR < 149 and ≥ 149 group, respectively. When multivariate analysis was performed, NLR ≥ 2.44 remained as a significant adverse factor for OS (p = 0.011) and PFS (p = 0.026). PLR > 149 also proved to be a significant factor for poorer OS (p = 0.003) and PFS (p = 0.021). Conclusions: Elevated pre-treatment NLR and PLR independently and in combination significantly predicted poor OS and PFS. Pre-treatment NLR and PLR are useful prognostic factors for OS and PFS in locally advanced pancreatic cancer patients.

Optimal indications for chemotherapy in elderly patients with unresectable pancreatic cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 450-450
Author(s):  
Shoichi Nakazuru ◽  
Shoji Nakamori ◽  
Seiya Kato ◽  
Ayaka Shoji ◽  
Ryosuke Kiyota ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Prognostic Factors ◽  
Elderly Patients ◽  
Performance Status ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Ct Scans ◽  
Unresectable Pancreatic Cancer ◽  
Cox Regression Analysis ◽  
Ecog Ps

450 Background: Pancreatic cancer is seen predominantly in elderly patients. Since many patients with pancreatic cancer have locally advanced unresectable tumors or distant metastases at diagnosis, they require chemotherapy. However, it is difficult to appropriately select elderly patients who are likely to benefit from chemotherapy. This study aimed to identify prognostic factors for elderly patients with unresectable pancreatic cancer treated with chemotherapy. Methods: We retrospectively analyzed the data of 191 patients with pancreatic cancer, aged ≥ 70 years, who had been diagnosed at our hospital between January 2006 and August 2016. Their overall survival (OS) was calculated using Kaplan-Meyer analysis. Prognostic factors were evaluated using Cox regression analysis. Results: Of the 191 patients, 52 patients with unresectable pancreatic cancer were treated with chemotherapy. Their median age was 76.5 years (range, 70–85 years). Twenty-two patients (42%) were men, and 44 (85%) had metastatic disease. Forty-one (79%) and 11 (21%) patients had ECOG performance status (PS) 0–1 and 2–3, respectively. Thirty-eight (73%), 10 (19%), and 4 (8%) patients received gemcitabine, gemcitabine-based combination regimens, and S-1, respectively, as first-line chemotherapy. The median OS was 219 days (range, 7–920 days). On univariate analysis, ECOG PS ≥ 2 (hazard ratio [HR], 4.37; P = 0.0005), carcinoembryonic antigen ≥ 10 ng/mL (HR, 2.32; P = 0.0162), serum AST ≥ 30 U/L (HR, 2.02; P = 0.0263), serum albumin < 3.0 g/dL (HR, 2.38; P = 0.0247), serum C-reactive protein ≥ 0.5 mg/dL (HR, 2.21; P = 0.0140), neutrophil-to-lymphocyte ratio ≥ 5.0 (HR, 3.25; P = 0.0066), and presence of ascites on computed tomography (CT) scans (HR, 3.02; P = 0.0016) were significantly associated with shorter survival times. On multivariate analysis, ECOG PS ≥ 2 (HR, 5.49; 95% confidence interval [CI], 2.18–13.32; P = 0.0005) and presence of ascites on CT scans (HR, 2.53; 95% CI, 1.20–5.24; P = 0.0148) were associated with poor OS. Conclusions: Elderly patients with unresectable pancreatic cancer who have a good performance status and do not show ascites on CT scans are likely to benefit from chemotherapy.

scholarly journals Induction Chemotherapy for Primarily Unresectable Locally Advanced Pancreatic Adenocarcinoma—Who Will Benefit from a Secondary Resection?

Medicina ◽  
2021 ◽  
Vol 57 (1) ◽  
pp. 77
Author(s):  
Nathalie Rosumeck ◽  
Lea Timmermann ◽  
Fritz Klein ◽  
Marcus Bahra ◽  
Sebastian Stintzig ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Neoadjuvant Therapy ◽  
Induction Therapy ◽  
Locally Advanced ◽  
Eastern Cooperative Oncology Group ◽  
Advanced Pancreatic Cancer ◽  
Comprehensive Cancer Center ◽  
Secondary Resection ◽  
Number Of Patients

Background and Objectives: An increasing number of patients (pts) with locally advanced pancreatic cancer (LAPC) are treated with an intensive neoadjuvant therapy to obtain a secondary curative resection. Only a certain number of patients benefit from this intention. The aim of this investigation was to identify prognostic factors which may predict a benefit for secondary resection. Materials and Methods: Survival time and clinicopathological data of pts with pancreatic cancer were prospective and consecutively collected in our Comprehensive Cancer Center Database. For this investigation, we screened for pts with primarily unresectable pancreatic cancer who underwent a secondary resection after receiving induction therapy in the time between March 2017 and May 2019. Results: 40 pts had a sufficient database to carry out a reliable analysis. The carbohydrate-antigen 19-9 (CA 19-9) level of the pts treated with induction therapy decreased by 44.7% from 4358.3 U/mL to 138.5 U/mL (p = 0.001). The local cancer extension was significantly reduced (p < 0.001), and the Eastern Cooperative Oncology Group (ECOG) performance status was lowered (p = 0.03). The median overall survival (mOS) was 20 months (95% CI: 17.2–22.9). Pts who showed a normal CA 19-9 level (<37 U/mL) at diagnosis and after neoadjuvant therapy or had a Body Mass Index (BMI) below 25 kg/m2 after chemotherapy had a significant prolonged overall survival (29 vs. 19 months, p = 0.02; 26 vs. 18 months, p = 0.04; 15 vs. 24 months, p = 0.01). Pts who still presented elevated CA 19-9 levels >400 U/mL after induction therapy did not profit from a secondary resection (24 vs. 7 months, p < 0.001). Nodal negativity as well as the performance of an adjuvant therapy lead to better mOS (25 vs. 15 months, p = 0.003; 10 vs. 25 months, p < 0.001). Conclusion: The pts in our investigation had different benefits from the multimodal treatment. We identified the CA 19-9 level at time of diagnosis and after neoadjuvant therapy as well as the preoperative BMI as predictive factors for overall survival. Furthermore, diagnostics of presurgical nodal status should gain more importance as nodal negativity is associated with better outcome.

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