title: Intensity-modulated radiotherapy for pancreatic adenocarcinoma.
abstract: OBJECTIVE
  To report the outcomes and toxicities in patients treated with intensity-modulated radiotherapy (IMRT) for pancreatic adenocarcinoma.
  
  
  METHODS
  Forty-seven patients with pancreatic adenocarcinoma were treated with IMRT between 2003 and 2008. Of these 47 patients, 29 were treated adjuvantly and 18 definitively. All received concurrent 5-fluorouracil chemotherapy. The treatment plans were optimized such that 95% of the planning target volume received the prescription dose. The median delivered dose for the adjuvant and definitive patients was 50.4 and 54.0 Gy, respectively.
  
  
  RESULTS
  The median age at diagnosis was 63.9 years. For adjuvant patients, the 1- and 2-year overall survival rate was 79% and 40%, respectively. The 1- and 2-year recurrence-free survival rate was 58% and 17%, respectively. The local-regional control rate at 1 and 2 years was 92% and 80%, respectively. For definitive patients, the 1-year overall survival, recurrence-free survival, and local-regional control rate was 24%, 16%, and 64%, respectively. Four patients developed Grade 3 or greater acute toxicity (9%) and four developed Grade 3 late toxicity (9%).
  
  
  CONCLUSIONS
  Survival for patients with pancreatic cancer remains poor. A small percentage of adjuvant patients have durable disease control, and with improved therapies, this proportion will increase. Systemic therapy offers the greatest opportunity. The present results have demonstrated that IMRT is well tolerated. Compared with those who received three-dimensional conformal radiotherapy in previously reported prospective clinical trials, patients with pancreatic adenocarcinoma treated with IMRT in our series had improved acute toxicity.
authors.affiliation: Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Abelson
authors.forename: James D
authors.initials: JD
authors.lastname: Murphy
authors.forename: Ann Yuriko
authors.initials: AY
authors.lastname: Minn
authors.forename: Melody
authors.initials: M
authors.lastname: Chung
authors.forename: George A
authors.initials: GA
authors.lastname: Fisher
authors.forename: James M
authors.initials: JM
authors.lastname: Ford
authors.forename: Pamela
authors.initials: P
authors.lastname: Kunz
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Norton
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Visser
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
authors.forename: Albert C
authors.initials: AC
authors.lastname: Koong
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Chang
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000379:methods / Q000401:mortality; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D005472:Fluorouracil; D000093542:Gemcitabine