title: Association of radiotherapy with favorable prognosis in daily clinical practice for treatment of locally advanced and metastatic pancreatic cancer.
abstract: OBJECTIVE
  Radiotherapy (RT) with or without chemotherapy is currently used in definitive therapy for advanced pancreatic cancer. We sought to evaluate the prognostic significance, pattern of care, and use of RT in locally advanced and metastatic pancreatic cancer.
  
  
  METHODS
  Between 2002 and 2011, patients with invasive pancreatic carcinoma and prior exposure to systemic chemotherapy were included. We used Cox regression model and propensity score matching for prognostic analyses and logistic regression for analyzing the factors impacting the use of RT.
  
  
  RESULTS
  We identified 217 pancreatic cancer patients (74 with unresectable stage II or III and 143 with stage IV). Of all patients, 90.8% had adenocarcinoma, and only 19.2% (42/217) received RT with doses ranging from 50 to 55 Gy in 25 to 28 fractions using modern RT techniques. Logistic regression showed stage (P < 0.001) and initial CA 19-9 level (P = 0.026) were significantly predictive of the choice of RT as a first-line treatment, whereas the second-line use of RT was associated with the response to first-line chemotherapy and longer progression-free survival. Patients with RT had a better median survival than those without it (14.6 vs 8.1 months, P < 0.001). In the multivariate analysis and propensity score matching, RT remained a good prognostic factor for overall survival.
  
  
  CONCLUSIONS
  The use of RT might be associated with a favorable clinical outcome in patients with locally advanced and metastatic pancreatic cancer. Further exploration of RT as a first-line therapy or second-line therapy for locally advanced or even metastatic pancreatic cancer is warranted.
authors.affiliation: Department of Oncology, Taipei, Taiwan.|Internal Medicine, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan.|Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Shih-Hung
authors.initials: SH
authors.lastname: Yang
authors.affiliation: Department of Oncology, Taipei, Taiwan.|Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Jhe-Cyuan
authors.initials: JC
authors.lastname: Guo
authors.affiliation: Department of Oncology, Taipei, Taiwan.|Cancer Research Center, Taipei, Taiwan.|Graduate Institute of Oncology, Taipei, Taiwan.|Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Kun-Huei
authors.initials: KH
authors.lastname: Yeh
authors.affiliation: Department of Surgery, Taipei, Taiwan.
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Tien
authors.affiliation: Department of Oncology, Taipei, Taiwan.|Internal Medicine, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan.|Cancer Research Center, Taipei, Taiwan.|Graduate Institute of Oncology, Taipei, Taiwan.
authors.forename: Ann-Lii
authors.initials: AL
authors.lastname: Cheng
authors.affiliation: Department of Oncology, Taipei, Taiwan.|Cancer Research Center, Taipei, Taiwan.|Graduate Institute of Oncology, Taipei, Taiwan.
authors.forename: Sung-Hsin
authors.initials: SH
authors.lastname: Kuo
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D016009:Chi-Square Distribution; D018450:Disease Progression; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D010818:Practice Patterns, Physicians'; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome
keywords: chemotherapy; pancreatic cancer; prognosis; radiotherapy; unresectable cancer