B100: Chemoradiotherapy for locally advanced pancreas adenocarcinoma at Weston Park Hospital and comparison with the SCALOP clinical trial
1Weston Park Hospital, Sheffield, UK
Inoperable locally advanced pancreatic adenocarcinoma has been treated with chemoradiotherapy since 2011 at Weston Park Hospital. The basis for this was the Selective Chemoradiation in Advanced Localised Pancreatic Cancer (SCALOP) trial. Induction chemotherapy utilised three cycles of four weekly Gemcitabine (1000mg/m2 on day 1, 8 and 15) and Capecitabine (830mg/m2 twice daily for 21 days) followed by a further cycle if stable or responding disease while radiotherapy was planned. 50.4 Gy in 28 fractions radiotherapy was given with concurrent Capecitabine chemotherapy 830mg/m2 twice daily. Rapidarc radiotherapy replaced 3-dimensional (3D) conformal radiotherapy in 2013. We wished to determine concordance with the SCALOP protocol for patient selection and treatment factors and assess survival outcomes for routine clinical use of the protocol.
Retrospective case note review. Information was collected about patient and disease characteristics and radiotherapy dose prescription and limits to assess concordance with the SCALOP protocol. Overall survival was calculated using the Kaplan-Meier method.
25 patients treated between 2011 and 2014. 14 were female and 11 male. Median age was 64 (range 46-78). All patients had locally advanced inoperable pancreatic cancer. Following induction chemotherapy 17 patients had stable disease and 8 had a response. All patients received 50.4 Gy in 28 fractions radiotherapy with concurrent Capecitabine chemotherapy. 16 cases used Rapidarc and 9 cases 3D conformal radiotherapy. All radiotherapy dose limits for target volume and organs at risk were maintained. Median overall survival was 13.5 months (range 5.8-28.6 months).
Overall survival of 13.5 months was slightly lower than 15.2 months observed in the SCALOP trial. This may relate to sample size, patient factors and real world practice. Radiotherapy was given via Rapidarc or conformal delivery within target volume and organ at risk dose contraints. We plan to reaudit with a larger sample size treated solely by Rapidarc to see if outcomes improve.