Predictive value of carbohydrate antigen 19-9 in pancreatic cancer treated with radiochemotherapy.
OBJECTIVE
To determine the predictive value of carbohydrate antigen (CA) 19-9 in pancreatic cancer treated with radiochemotherapy.


METHODS
Ninety-five patients with locally advanced unresectable adenocarcinoma of the pancreas were treated with hyperfractionated accelerated radiotherapy to a total dose of 44.8 Gy combined with 5-fluorouracil and folinic acid. CA 19-9 was measured before therapy, each week during therapy, and every 4 weeks during the follow-up period.


RESULTS
The median CA 19-9 before treatment was 420 U/mL; in the responder group it was 117 U/mL, and in the nonresponder group it was 806 U/mL. Patients with a pretreatment CA 19-9 less than the median had not only a significantly better tumor response (45.8%) but also a better survival prognosis (median survival 12.3 months) than those with a level higher than the median (tumor response 12.8%; median survival 7.1 months). The posttreatment median CA 19-9 for all patients also exhibited prognostic significance. The median survival of patients with a CA 19-9 level lower than the posttreatment median of 293 U/mL was 13.5 months, compared with 7.2 months for those with a CA 19-9 level greater than the median. To detect recurrent disease during follow-up, the sensitivity of CA 19-9 was 100% and the specificity 88%.


CONCLUSIONS
Our results indicate that CA 19-9 is of predictive value for prognosis, response, and detecting recurrence of pancreatic cancer in patients undergoing combined radiochemotherapy. Therefore, we recommend the routine implementation of CA 19-9 observation during the clinical course of treatment for patients with pancreatic cancer undergoing radiochemotherapy.
Micke
Oliver
O
Department of Radiotherapy, Münster University Hospital, Münster, Germany. omicke@uni-muenster.de
Bruns
Frank
F
Kurowski
Rene
R
Horst
Eckehard
E
deVries
Alexander F
AF
Hausler
John W
JW
Willich
Normann
N
Schäfer
Ulrich
U
D000230:Adenocarcinoma / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001317:Austria / Q000453:epidemiology; D018395:CA-19-9 Antigen / Q000097:blood*; D003131:Combined Modality Therapy / Q000379:methods; D005472:Fluorouracil / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000532:radiotherapy*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016019:Survival Analysis
D018395:CA-19-9 Antigen; D002955:Leucovorin; D005472:Fluorouracil