Hypofractionated intensity-modulated radiotherapy with concurrent chemotherapy for elderly patients with locally advance
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RESEARCH
Hypofractionated intensity‑modulated radiotherapy with concurrent chemotherapy for elderly patients with locally advanced pancreatic carcinoma Takahiro Iwai1, Michio Yoshimura1*, Ryo Ashida1, Yoko Goto1, Takahiro Kishi1, Satoshi Itasaka1,2, Keiko Shibuya1,3, Masashi Kanai4, Toshihiko Masui5, Akihisa Fukuda6, Hiroyoshi Isoda7, Masahiro Hiraoka1,8 and Takashi Mizowaki1
Abstract Background: It is important to understand how elderly patients with locally advanced pancreatic carcinoma (LAPC) should be treated, since the number of elderly cancer patients will increase. However, the optimal treatment for elderly patients with LAPC remains unclear. The purpose of this study was to evaluate the efficacy and safety of hypofractionated intensity-modulated radiotherapy (IMRT) with concurrent gemcitabine for elderly patients with LAPC. Methods: We retrospectively analysed the data from LAPC patients aged ≥ 75 years treated with hypofractionated IMRT (48 Gy in 15 fractions) with concurrent weekly gemcitabine at our institution from February 2013 to December 2018. Overall survival (OS), progression-free survival (PFS), locoregional progression-free survival (LRPFS), distant metastasis-free survival (DMFS), and the pattern of recurrence and toxicity were analysed. Results: Fifteen patients received treatment during the study period. The median age was 78 years (range 75–86 years), and the Eastern Cooperative Oncology Group (ECOG) performance status (PS) of all patients was 0–1. The median survival time (MST) and median PFS were 20.4 [95% confidence interval (CI) 10.3–36.8] and 13.5 (95% CI 6.4–20.3) months, respectively, and the 1-year OS and PFS rates were 80.0% (95% CI 50–93.1%) and 66.7% (95% CI 37.5–84.6%), respectively. The median LRPFS and median DMFS were 15.6 (95% CI 6.4–36.8) and 14.9 (95% CI 7.0–20.5) months, respectively, and the 1-year LRPFS and DMFS rates were 73.3% (95% CI 43.6–89.1%) and 66.7% (95% CI 37.5– 84.6%), respectively. Non-haematologic grade 3 toxicity was observed in three cases, of which only one was induced by radiotherapy, whereas grade 4–5 non-haematologic acute or late toxicities were not observed. Conclusions: The OS and PFS of elderly patients with LAPC treated using hypofractionated IMRT with concurrent gemcitabine were favourable and without the occurrence of severe toxicity. This treatment strategy is feasible and promising for elderly LAPC patients with good PS.
*Correspondence: [email protected]‑u.ac.jp 1 Department of Radiation Oncology and Image‑Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin‑Kawaharacho, Sakyo‑ku, Kyoto 606‑8507, Japan Full list of author information is available at the end of the article
Background Pancreatic carcinoma is a malignancy with a very poor prognosis. Approximately 30% of pancreatic carcinoma patients have unresectable locally advanced pancreatic carcinoma (LAPC) during diagnosis, with the prognosis of LAPC being poor [1]. The standard treatment for LAPC is chemotherapy (CTX) alone or concurrent chemoradiot
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