title: Gastrointestinal hemorrhage after concurrent chemoradiotherapy in locally advanced pancreatic cancer.
abstract: OBJECTIVE
  While chemoradiotherapy (CRT) is considered to be a reasonable treatment for locally advanced pancreatic cancer (LAPC), there is little information about the associated risk of gastrointestinal (GI) hemorrhage. We investigated the clinical features of GI toxicity after CRT in patients with LAPC and examined the effect of GI hemorrhage on survival.
  
  
  METHODS
  Patients enrolled in this study had received CRT for pathologically proven LAPC. Their medical records were retrospectively reviewed.
  
  
  RESULTS
  A total of 156 patients with LAPC (median age, 65 years; range, 39 to 90 years) who received treatment between August 2005 and March 2009 were included in this study. The most common GI toxicities were ulcer formation (25.6%) and hemorrhage (25.6%), and the most common grade 3 to grade 5 GI toxicity was hemorrhage (65%). The origins of GI hemorrhage were gastric ulcer (37.5%), duodenal ulcer (37.5%), and radiation gastritis (15.0%). The independent risk factor for GI hemorrhage was tumor location in the pancreatic body. The median overall survival of the patients with a GI hemorrhage was 13.8 months (range, 2.8 to 50.8 months) and was not significantly different from that of patients without GI hemorrhage.
  
  
  CONCLUSIONS
  GI hemorrhage was common in patients with LAPC after CRT. Although GI hemorrhage was controlled with endoscopic hemostasis, preventive measures should be investigated to reduce needless suffering.
authors: Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Kyong Joo
authors: KJ
authors: Lee
authors: Hee Man
authors: HM
authors: Kim
authors: Joo Won
authors: JW
authors: Jung
authors: Moon Jae
authors: MJ
authors: Chung
authors: Jeong Youp
authors: JY
authors: Park
authors: Seungmin
authors: S
authors: Bang
authors: Seung Woo
authors: SW
authors: Park
authors: Woo Jung
authors: WJ
authors: Lee
authors: Jin Sil
authors: JS
authors: Seong
authors: Si Young
authors: SY
authors: Song
keywords: Chemoradiotherapy; Gastrointestinal hemorrhage; Pancreatic neoplasms; Toxicities