title: Intensity modulated radiotherapy as neoadjuvant chemoradiation for the treatment of patients with locally advanced pancreatic cancer. Outcome analysis and comparison with a 3D-treated patient cohort.
abstract: BACKGROUND
  To evaluate outcome after intensity modulated radiotherapy (IMRT) compared to 3D conformal radiotherapy (3D-RT) as neoadjuvant treatment in patients with locally advanced pancreatic cancer (LAPC).
  
  
  METHODS
  In total, 57 patients with LAPC were treated with IMRT and chemotherapy. A median total dose of 45 Gy to the PTV_baseplan and 54 Gy to the PTV_boost in single doses of 1.8 Gy for the PTV_baseplan and median single doses of 2.2 Gy in the PTV_boost were applied. Outcomes were evaluated and compared to a large cohort of patients treated with 3D-RT.
  
  
  RESULTS
  Overall treatment was well tolerated in all patients and IMRT could be completed without interruptions. Median overall survival was 11 months (range 5-37.5 months). Actuarial overall survival at 12 and 24 months was 36 % and 8 %, respectively. A significant impact on overall survival could only be observed for a decrease in CA 19-9 during treatment, patients with less pre-treatment CA 19-9 than the median, as well as weight loss during treatment. Local progression-free survival was 79 % after 6 months, 39 % after 12 months, and 13 % after 24 months. No factors significantly influencing local progression-free survival could be identified. There was no difference in overall and progression-free survival between 3D-RT and IMRT. Secondary resectability was similar in both groups (26 % vs. 28 %). Toxicity was comparable and consisted mainly of hematological toxicity due to chemotherapy.
  
  
  CONCLUSIONS
  IMRT leads to a comparable outcome compared to 3D-RT in patients with LAPC. In the future, the improved dose distribution, as well as advances in image-guided radiotherapy (IGRT) techniques, may improve the use of IMRT in local dose escalation strategies to potentially improve outcome.
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. Stephanie.Combs@med.uni-heidelberg.de
authors.forename: S E
authors.initials: SE
authors.lastname: Combs
authors.forename: D
authors.initials: D
authors.lastname: Habermehl
authors.forename: K
authors.initials: K
authors.lastname: Kessel
authors.forename: F
authors.initials: F
authors.lastname: Bergmann
authors.forename: J
authors.initials: J
authors.lastname: Werner
authors.forename: I
authors.initials: I
authors.lastname: Brecht
authors.forename: P
authors.initials: P
authors.lastname: Schirmacher
authors.forename: D
authors.initials: D
authors.lastname: Jäger
authors.forename: M W
authors.initials: MW
authors.lastname: Büchler
authors.forename: J
authors.initials: J
authors.lastname: Debus
mesh_terms: D000328:Adult; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D020266:Radiotherapy, Conformal / Q000379:methods*; D016896:Treatment Outcome
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