Understanding the role of chemo-radiotherapy in locally advanced, inoperable pancreatic adenocarcinoma as consolidation treatment after successful chemotherapy – which patients benefit?


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Arvind Arora1, Callum Eley2, Ankit Rao1
1Nottingham City Hospital, 2University of Nottingham

Abstract

Background

Pancreatic cancer is the cancer of unmet need with dismal survival, with a 5-year survival rate of <10%. Chemotherapy leads to improved outcomes for patients with locally advanced pancreatic cancer but can lead to significant toxicity and the role of radiotherapy has been debated. Only certain patients benefit from chemoradiotherapy, and so we aimed to investigate any predictive prognostic factors in order to develop refined selection criteria for clinicians as to when it is appropriate to recommend chemoradiotherapy.

Method

19 adult patients with histologically proven locally advanced pancreatic cancer who had undergone chemotherapy followed by radiotherapy or chemoradiotherapy were included in this study. Data was collected using NHS patient electronic record systems (NOTIS and ChemoCare). Statistical analysis was carried out using SPSS (version 22 Chicago, IL).

Results

Median OS in patients with baseline CA19-9 levels of <400 kU/L was 29.0 months (95% CI, 12.9-45.1) compared to 16.0 months (95% CI, 8.3-23.7) in those with baseline levels ≥400 kU/L (p = 0.002). Median OS in patients with post-chemotherapy CA19-9 levels of <200 kU/L (excluding one patient as an outlier) was 20.0 months (95% CI, 17.4-22.6) compared to 13.0 months (95% CI, 11.9-14.1) in those with levels ≥200 kU/L (p = 0.024). Median OS in patients with a PS of 0 prior to commencing chemotherapy was 29.0 months (95% CI, 13.0-45.0) compared to 17.0 months (95% CI, 15.8-18.2) in those with a PS of 1 (p = 0.005).

Conclusion

CA19-9 levels before chemotherapy (p=0.002), before radiotherapy (p=0.024), and PS prior to chemotherapy (p=0.005) could be used as predictive factors with regards to survival for LAPC. Patients that waited >50 days from finishing chemotherapy to starting radiotherapy achieved better outcomes. Areas of interest for future research include the time between interventions, RT dose, further interventions following RT, the role of staging laparoscopy and albumin levels, CRP to albumin ratio, weight loss, and CEA as prognostic factors.

Impact statement

Pancreatic cancer is cancer with poor survival and a better understanding of biomarkers is needed to improve patient outcomes & spare unnecessary toxicity.