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J Korean Soc Ther Radiol Oncol > Volume 24(1); 2006 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2006;24(1): 11-20.
Locally Advanced, Unresectable Pancreatic Cancer Treated by Stereotactic Radiation Therapy
Chul Won Choi, Mi Sook Kim, Chul Koo Cho, Seong Yul Yoo, Kwang Mo Yang, Hyung Jun Yoo, Dong Han Lee, Young Hoon Ji, Chul Ju Han, Jin Kim, Young Han Kim
1Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea. mskim@kcch.re.kr
2Department of Internal Medicine, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
3Department of Radiology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
ABSTRACT
PURPOSE:
In order to find out whether stereotactic radiation therapy (RT) using CyberKnife (CK) could improve survival rate and lower acute toxicity compared to conventional RT.
MATERIALS AND METHODS:
From April 2003 through April 2004, 19 patients with Eastern Cooperative Oncology Group (ECOG) performance status < or =3 and locally advanced pancreas cancer without distant metastasis, evaluated by CT or PET/CT, were included. We administered stereotactic RT consisting of either 33 Gy, 36 Gy or 39 Gy in 3 fractions to 6, 4 and 9 patients, respectively, in an effort to increase the radiation dose step by step, and analyzed the survival rate and gastrointestinal toxicities by the acute radiation morbidity criteria of Radiation Therapeutic Oncology Group (RTOG). Prognostic factors of age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA19-9, planning target volume (PTV), and adjacent organ and vessel invasion on CT scan were evaluated by Log Rank test.
RESULTS:
The median survival time was 11 months with 1-year survival rate of 36.8%. During follow-up period (range 3~20 months, median 10 months), no significant gastrointestinal acute toxicity (RTOG grade 3) was observed. In univariate analysis, age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA19-9 level, and adjacent organ and vessel invasion did not show any significant changes of survival rate, however, patients with PTV (80 cc showed more favorable survival rate than those with PTV >80 cc (p-value<0.05). In multivariate analysis, age younger than 65 years and PTV >80 cc showed better survival rate.
CONCLUSION:
In terms of survival, the efficacy of stereotactic radiation therapy using CK was found to be superior or similar to other recent studies achieved with conventional RT with intensive chemotherapy, high dose conformal RT, intraoperative RT (IORT), or intensity modulated RT (IMRT). Furthermore, severe toxicity was not observed. Short treatment time in relation to the short life expectancy gave patients more convenience and, finally, quality of life would be increased. Consequently, this could be regarded as an effective novel treatment modality for locally advanced, unresectable pancreas cancer. PTV would be a helpful prognostic factor for CK.
Key Words: Pancreatic cancer, Stereotactic radiation therapy, CyberKnife
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