title: Definitive Chemoradiation With Full-dose Gemcitabine for Unresectable Pancreatic Cancer: Efficacy of Involved-Field Radiotherapy.
abstract: OBJECTIVE
  Definitive chemoradiotherapy for unresectable pancreatic cancer has traditionally involved 5-fluorouracil-based chemotherapy. Our institution has a long history of combining gemcitabine and radiotherapy (RT), and performed a retrospective review of all patients treated in this manner.
  
  
  METHODS
  We reviewed the records of 180 patients treated from 1999 to 2012. Mean RT dose was 40.9 Gy in 2.2-Gy fractions, and targeted only radiographically apparent disease. Ninety-six percent of patients received full-dose gemcitabine-based chemotherapy with RT. Kaplan-Meier was used to analyze time-to-event endpoints, and Cox regression models were used to assess significant prognostic variables.
  
  
  RESULTS
  Eighty-nine percent of patients completed RT without a toxicity-related treatment break. Median follow-up was 10.2 months. Twenty-nine percent of patients had a radiographic decrease in primary tumor size following treatment. Median overall survival was 11.8 months, time to distant metastasis (TDM) was 6.7 months, and time to local recurrence (TLR) was 8.3 months. On multivariate analysis, male sex, lower performance status, and higher posttreatment CA 19-9 level predicted for worse overall survival. Posttreatment, CA 19-9 was also associated with TDM and TLR, and radiographic tumor response was associated with better TLR.
  
  
  CONCLUSIONS
  Definitive chemoradiation using full-dose gemcitabine is well tolerated and achieves survival outcomes comparable to reported trials in the literature.
authors.affiliation: Departments of *Radiation Oncology ‡Biostatistics ∥Surgery, University of Michigan §Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan †University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Jessica
authors.initials: J
authors.lastname: Zhou
authors.forename: Charles X
authors.initials: CX
authors.lastname: Fang
authors.forename: Jincheng
authors.initials: J
authors.lastname: Shen
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schipper
authors.forename: Mark M
authors.initials: MM
authors.lastname: Zalupski
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Minter
authors.forename: Diane M
authors.initials: DM
authors.lastname: Simeone
authors.forename: Deanna
authors.initials: D
authors.lastname: Hart
authors.forename: Taylor
authors.initials: T
authors.lastname: Eagle
authors.forename: Grace W
authors.initials: GW
authors.lastname: Kimmel
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Vainshtein
authors.forename: Theodore S
authors.initials: TS
authors.lastname: Lawrence
authors.forename: Mary
authors.initials: M
authors.lastname: Feng
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000379:methods*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011878:Radiotherapy / Q000379:methods; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine