title: Intensity-modulated radiotherapy in treatment of pancreatic and bile duct malignancies: toxicity and clinical outcome.
abstract: OBJECTIVE
  To assess the efficacy and toxicity of intensity-modulated radiotherapy (IMRT) in pancreatic and bile duct (cholangiocarcinoma) malignancies.
  
  
  METHODS
  Twenty-five patients with pancreatic and bile duct cancer were treated with IMRT. Twenty-three received concurrent 5-fluoruracil. One patient with a pancreatic primitive neuroectodermal tumor received concurrent etoposide and ifosfamide. Eight patients had resected tumors, and 17 had unresectable primary (n = 14) or recurrent (n = 3) tumors. Six patients underwent treatment planning with conventional three-dimensional four-field techniques for dosimetric comparison with IMRT.
  
  
  RESULTS
  Compared with conventional RT, IMRT reduced the mean dose to the liver, kidneys, stomach, and small bowel. IMRT was well tolerated, with 80% experiencing Grade 2 or less acute upper GI toxicity. At a median follow-up of 10.2 months, no resected patients had local failure, and only 1 of 10 assessable patients with unresectable cancer had local progression. The median survival and distant metastasis-free survival of the 24 patients with adenocarcinoma was 13.4 and 7.3 months, respectively. Grade 4 late liver toxicity occurred in 1 patient surviving >5 years. The remainder of the assessable patients experienced no (n = 9) or Grade 1 (n = 4) late toxicity.
  
  
  CONCLUSIONS
  In this hypothesis-generating analysis, the acute and chronic toxicity profile with IMRT in the treatment of pancreatic and bile duct cancer was encouraging. Local control was not compromised, despite efforts to increase conformality and avoid doses to normal structures. Distant failure remains a major obstacle in pancreatic cancer.
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA. mmilano@radonc.uchicago.edu
authors.forename: Michael T
authors.initials: MT
authors.lastname: Milano
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Chmura
authors.forename: Michael C
authors.initials: MC
authors.lastname: Garofalo
authors.forename: Carla
authors.initials: C
authors.lastname: Rash
authors.forename: John C
authors.initials: JC
authors.lastname: Roeske
authors.forename: Phillip P
authors.initials: PP
authors.lastname: Connell
authors.forename: Oh-Hoon
authors.initials: OH
authors.lastname: Kwon
authors.forename: Ashesh B
authors.initials: AB
authors.lastname: Jani
authors.forename: Ruth
authors.initials: R
authors.lastname: Heimann
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008875:Middle Aged; D017599:Neuroectodermal Tumors / Q000188:drug therapy / Q000532:radiotherapy; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D020266:Radiotherapy, Conformal / Q000009:adverse effects* / Q000379:methods*
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil