Feasibility analysis of tomotherapy for advanced pancreatic carcinoma

ZHOU Bin; SUN Xiangdong; DING Wei; FU Chenchun; GU Xin; SHEN Fangcheng

doi:10.3969/j.issn.1009-0460.2017.11.012

Abstract：Objective To explore the feasibility and clinical outcome of tomotherapy (TOMO) in patients with advanced pancreatic cancer.Methods Seventy-one patients with advanced pancreatic cancer including primarily unresectable disease,metastasis disease and recurrence after curative surgery were included in the study.Thirty-nine cases were diagnosed by pathology and 32 cases of clinical diagnosis.A total of 266 target areas were treated including 71 cases of primary lesions,56 cases of regional lymph nodes and 139 cases of liver metastases.The total doses to gross volume were 50-70 Gy in pancreatic,54-65 Gy in lymph nodes and 59.4-65 Gy in metastasis liver.Forty-four patients received concurrent chemotherapy,and 25 patients received sequential chemotherapy.The efficacy and safety were evaluated by RECIST 1.1 and NCI-CTC 4.0 criteria.Overall survival (OS) was analyzed by Kaplan-Meier method.The factors affecting the prognosis were analyzed by Cox risk proportional regression model.Results All the 71 patients completed the radiotherapy plan.The response rate and disease control rate were 61.7％ and 98.9％ in 266 target areas,respectively.Univariate analysis showed that clinical stage,M stage,CA199 level,PS scores,concurrent chemotherapy and adjuvant chemotherapy were associated with prognosis (P ＜ 0.05).Multivariate analysis showed that M stage,PS scores,concurrent chemotherapy,adjuvant chemotherapy and CA199 were independent prognostic factors for OS.The main acute reactions were fatigue,digestive tract reaction and bone marrow suppression of grade 1-2.After symptomatic treatment,all patients were able to tolerate and complete treatment without treatment-related deaths and acute toxicity of grade 3-4.Conclusion TOMO with concurrent chemotherapy is a feasible option without significant toxicities for patients with advanced pancreatic cancer.Especially for patients with advanced liver metastasis or even multiple metastases,concurrent chemoradiotherapy is expected to achieve good results.