title: Treatment of locally advanced unresectable pancreatic cancer: a 10-year experience.
abstract: OBJECTIVE
  We retrospectively analyzed the results of patients with locally advanced unresectable pancreatic cancer (LAPC) treated with either chemoradiation (CRT) or chemotherapy alone over the past decade.
  
  
  METHODS
  Between December 1998 and October 2009, 116 patients with LAPC were treated at our institution. Eighty-four patients received concurrent chemoradiation [RT (+) group], primarily 5-flourouracil based (70%). Thirty-two patients received chemotherapy alone [RT (-) group], the majority gemcitabine based (78%). Progression-free survival (PFS) and overall survival (OS) were calculated from date of diagnosis to date of first recurrence and to date of death or last follow-up, respectively. Univariate statistical analysis was used to determine significant prognostic factors for overall survival.
  
  
  RESULTS
  Median patient age was 67 years. Sixty patients were female (52%). Median follow-up was 11 months (range, 1.6-59.4 months). The RT (+) group received a median radiation dose of 50.4 Gy, was more likely to present with ECOG 0-1 performance status, and experienced less grade 3-4 toxicity. PFS was 10.9 versus 9.1 months (P=0.748) and median survival was 12.5 versus 9.1 months (P=0.998) for the RT (+) and RT (-) groups respectively (P=0.748). On univariate analysis, patients who experienced grade 3-4 toxicity had worse overall survival than those who did not (P=0.02).
  
  
  CONCLUSIONS
  Optimal management for LAPC continues to evolve. Patients who developed treatment-related grade 3-4 toxicity have a poorer prognosis. Survival rates were not statistically significant between chemotherapy and chemoradiotherapy groups.
authors.affiliation: Departments of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, California, USA.
authors.forename: Nadia K
authors.initials: NK
authors.lastname: Malik
authors.forename: Kilian Salerno
authors.initials: KS
authors.lastname: May
authors.forename: Rameela
authors.initials: R
authors.lastname: Chandrasekhar
authors.forename: Wen
authors.initials: W
authors.lastname: Wee
authors.forename: Leayn
authors.initials: L
authors.lastname: Flaherty
authors.forename: Renuka
authors.initials: R
authors.lastname: Iyer
authors.forename: John
authors.initials: J
authors.lastname: Gibbs
authors.forename: Boris
authors.initials: B
authors.lastname: Kuvshinoff
authors.forename: Gregory
authors.initials: G
authors.lastname: Wilding
authors.forename: Graham
authors.initials: G
authors.lastname: Warren
authors.forename: Gary Y
authors.initials: GY
authors.lastname: Yang