title: Utility of serum CA 19-9 monitoring in preoperative radiotherapy for pancreatic cancer.
abstract: OBJECTIVE
  Pancreatic cancer is extremely refractory even to aggressive treatments including surgery, resulting in early metastasis and/or local recurrence. We investigated changes in serum tumor marker CA 19-9 levels during preoperative radiotherapy in conjunction with initial treatment failure.
  
  
  METHODS
  Twenty-three patients presenting with localized disease and an increased serum CA 19-9 level, who were slated to undergo pancreatectomy and/or intraoperative radiotherapy following preoperative radiotherapy were reviewed. CA 19-9 response, the ratio of post-radiotherapy level before laparotomy to pre-radiotherapy level, was analyzed in relation to disease-control time and survival.
  
  
  RESULTS
  Eleven patients revealed metastasis at restaging or laparotomy; 12 patients (52%) completed aggressive treatments. Initial failure was identified at the liver (52%), peritoneum (52%), or local site (26%) with a median disease-control time of 91 days; 7 patients showed combined failure. All but 1 patient died of cancer with a median survival time of 264 days. CA 19-9 response (range: 0-1185%) did not correlate with disease-control time or survival; 8 progressive-disease patients (> 140% response), however, showed significantly shorter disease-control time than 15 nonprogressive-disease patients (< or = 140% response).
  
  
  CONCLUSIONS
  CA 19-9 monitoring is useful in preoperative radiotherapy for identifying patients who will not benefit by succeeding aggressive treatments by predicting early metastasis.
authors.affiliation: Department of Radiology, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba City 305-8575, Japan. ki-ohara@md.tsukuba.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Ohara
authors.forename: H
authors.initials: H
authors.lastname: Tatsuzaki
authors.forename: N G
authors.initials: NG
authors.lastname: Molotkova
authors.forename: T
authors.initials: T
authors.lastname: Oda
authors.forename: K
authors.initials: K
authors.lastname: Yuzawa
authors.forename: Y
authors.initials: Y
authors.lastname: Saida
authors.forename: Y
authors.initials: Y
authors.lastname: Matsuzaki
authors.forename: W
authors.initials: W
authors.lastname: Shimizu
authors.forename: T
authors.initials: T
authors.lastname: Todoroki
authors.forename: K
authors.initials: K
authors.lastname: Fukao
authors.forename: N
authors.initials: N
authors.lastname: Tanaka
authors.forename: Y
authors.initials: Y
authors.lastname: Itai
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000097:blood / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D017211:Treatment Failure
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen