Feasibility of intensity-modulated radiotherapy combined with gemcitabine and S-1 for patients with pancreatic cancer

Kennoki,Norifumi; Nakayama,Hidetsugu; Nagakawa,Yuichi; Hosokawa,Yuichi; Itonaga,Tomohiro; Tajima,Yu; Shiraishi,Sachica; Mikami,Ryuji; Tsuchida,Akihiko; Tokuuye,Koichi

doi:10.3892/mco.2015.664

Feasibility of intensity-modulated radiotherapy combined with gemcitabine and S-1 for patients with pancreatic cancer

Authors:
- Norifumi Kennoki
- Hidetsugu Nakayama
- Yuichi Nagakawa
- Yuichi Hosokawa
- Tomohiro Itonaga
- Yu Tajima
- Sachica Shiraishi
- Ryuji Mikami
- Akihiko Tsuchida
- Koichi Tokuuye
View Affiliations

Affiliations: Department of Radiology, Tokyo Medical University, Shinjyuku, Tokyo 160‑0023, Japan, Third Department of Surgery, Tokyo Medical University, Shinjyuku, Tokyo 160‑0023, Japan
Published online on: October 29, 2015 https://doi.org/10.3892/mco.2015.664
Pages: 43-46

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The aim of the present study was to establish whether intensity-modulated radiotherapy (IMRT) with concurrent gemcitabine and S-1 is a feasible treatment option for patients with locally advanced pancreatic ductal adenocarcinoma. Patients with pancreatic ductal adenocarcinoma were prospectively enrolled. An IMRT dose of 50.4 Gy in 28 fractions with concurrent gemcitabine at a dose of 600 mg/m2 and S‑1 at a dose of 60 mg were administrated. Adverse events and associated dosimetric factors were assessed. Between February 2012 and January 2014, 17 patients with borderline resectable and 4 with unresectable pancreatic cancer were enrolled. None of the patients experienced grade 3 or worse nausea and vomiting. The planning target volume (≥200 vs. <200 ml) was a statistically significant predictive factor for neutrocytopenia (≥500 vs. 500/µl, P=0.02). Concurrent IMRT with gemcitabine and S‑1 for patients with locally advanced pancreatic cancer is feasible, with tolerable hematological toxicities and low gastrointestinal toxicities.

View Figures

View References

1	Matsuno S, Egawa S, Fukuyama S, Motoi F, Sunamura M, Isaji S, Imaizumi T, Okada S, Kato H, Suda K, et al: Pancreatic cancer registry in Japan: 20 years of experience. Pancreas. 28:219–230. 2004. View Article : Google Scholar : PubMed/NCBI
2	Siegel R, Ma J, Zou Z and Jemal A: Cancer statistics, 2014. CA Cancer J Clin. 64:9–29. 2014. View Article : Google Scholar : PubMed/NCBI
3	Imamura M, Doi R, Imaizumi T, Funakoshi A, Wakasugi H, Sunamura M, Ogata Y, Hishinuma S, Asano T, Aikou T, et al: A randomized multicenter trial comparing resection and radiochemotherapy for resectable locally invasive pancreatic cancer. Surgery. 136:1003–1011. 2004. View Article : Google Scholar : PubMed/NCBI
4	Bilimoria KY, Talamonti MS, Sener SF, Bilimoria MM, Stewart AK, Winchester DP, Ko CY and Bentrem DJ: Effect of hospital volume on margin status after pancreaticoduodenectomy for cancer. J Am Coll Surg. 207:510–519. 2008. View Article : Google Scholar : PubMed/NCBI
5	Klautke G and Brunner TB: Radiotherapy in pancreatic cancer. Strahlenther Onkol. 184:557–564. 2008. View Article : Google Scholar : PubMed/NCBI
6	Ueno H, Ioka T, Ikeda M, Ohkawa S, Yanagimoto H, Boku N, Fukutomi A, Sugimori K, Baba H, Yamao K, et al: Randomized phase III study of gemcitabine plus S-1, S-1 alone, or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan: GEST study. J Clin Oncol. 31:1640–1648. 2013. View Article : Google Scholar : PubMed/NCBI
7	Motoi F, Ishida K, Fujishima F, Ottomo S, Oikawa M, Okada T, Shimamura H, Takemura S, Ono F, Akada M, et al: Neoadjuvant chemotherapy with gemcitabine and S-1 for resectable and borderline pancreatic ductal adenocarcinoma: Results from a prospective multi-institutional phase 2 trial. Ann Surg Oncol. 20:3794–3801. 2013. View Article : Google Scholar : PubMed/NCBI
8	Moertel CG, Frytak S, Hahn RG, O'Connell MJ, Reitemeier RJ, Rubin J, Schutt AJ, Weiland LH, Childs DS, Holbrook MA, et al: Therapy of locally unresectable pancreatic carcinoma: A randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads+5-fluorouracil) and high dose radiation+5-fluorouracil: The gastrointestinal tumor study group. Cancer. 48:1705–1710. 1981. View Article : Google Scholar : PubMed/NCBI
9	Loehrer PJ Sr, Feng Y, Cardenes H, Wagner L, Brell JM, Cella D, Flynn P, Ramanathan RK, Crane CH, Alberts SR and Benson AB III: Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: An Eastern Cooperative Oncology Group trial. J Clin Oncol. 29:4105–4112. 2011. View Article : Google Scholar : PubMed/NCBI
10	Pisters PW, Hudec WA, Lee JE, Raijman I, Lahoti S, Janjan NA, Rich TA, Crane CH, Lenzi R, Wolff RA, et al: Preoperative chemoradiation for patients with pancreatic cancer: Toxicity of endobiliary stents. J Clin Oncol. 18:860–867. 2000.PubMed/NCBI
11	Krishnan S, Rana V, Janjan NA, Varadhachary GR, Abbruzzese JL, Das P, Delclos ME, Gould MS, Evans DB and Wolff RA: Induction chemotherapy selects patients with locally advanced, unresectable pancreatic cancer for optimal benefit from consolidative chemoradiation therapy. Cancer. 110:47–55. 2007. View Article : Google Scholar : PubMed/NCBI
12	Yovino S, Poppe M, Jabbour S, David V, Garofalo M, Pandya N, Alexander R, Hanna N and Regine WF: Intensity-modulated radiation therapy significantly improves acute gastrointestinal toxicity in pancreatic and ampullary cancers. Int J Radiat Oncol Biol Phys. 79:158–162. 2011. View Article : Google Scholar : PubMed/NCBI
13	Ben-Josef E, Shields AF, Vaishampayan U, Vaitkevicius V, El-Rayes BF, McDermott P, Burmeister J, Bossenberger T and Philip PA: Intensity-modulated radiotherapy (IMRT) and concurrent capecitabine for pancreatic cancer. Int J Radiat Oncol Biol Phys. 59:454–459. 2004. View Article : Google Scholar : PubMed/NCBI
14	Murphy JD, Adusumilli S, Griffith KA, Ray ME, Zalupski MM, Lawrence TS and Ben-Josef E: Full-dose gemcitabine and concurrent radiotherapy for unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys. 68:801–808. 2007. View Article : Google Scholar : PubMed/NCBI
15	Nakamura A, Shibuya K, Matsuo Y, Nakamura M, Shiiinoki T, Mizowaki T and Hiraoka M: Analysis of dosimetric parameters associated with acute gastrointestinal toxicity and upper gastrointestinal bleeding in locally advanced pancreatic cancer patients treated with gemcitabine-based concurrent chemoradiotherapy. Int J Radiat Oncol Biol Phys. 84:369–375. 2012. View Article : Google Scholar : PubMed/NCBI