title: Chemotherapy and intensity-modulated radiation therapy for locally advanced pancreatic cancer achieves a high rate of R0 resection.
abstract: BACKGROUND
  To assess local control, survival and conversion to resectability among locally advanced pancreatic cancer (LAPC) patients treated with induction chemotherapy (ICT) followed by chemoradiotherapy treatment using intensity-modulated radiation therapy (IMRT).
  
  
  METHODS
  Between 2007 and 2012, 134 LAPC patients were treated with ICT followed by IMRT. After chemoradiotherapy, 40 patients received maintenance chemotherapy.
  
  
  RESULTS
  With a median follow-up of 20 months, median overall survival (OS) was 23 months. One- and two-year OS was 85% and 47%, respectively. On multivariate analysis, progression of disease after IMRT was associated with worse OS. Cumulative incidence of local failure was 10% at one year and 36% at two years. Twenty-six patients (19%) underwent resection after chemoradiotherapy including 22 patients (85%) with negative margins. On multivariate analysis, response to IMRT was associated with surgery (p = .01). Acute grade 3-4 hematologic and non-hematologic toxicity rates were 26% and 4.5%, respectively.
  
  
  CONCLUSIONS
  IMRT is safe in patients with LAPC. Patients with non-progressive LAPC after ICT and who received IMRT had high rates of local control and prolonged survival.
authors: a Department of Radiation Oncology , Tenon Hospital, Hôpitaux Universitaires Est Parisien, University Pierre and Marie Curie Paris VI , Paris , France.|b Department of Radiation Oncology at Memorial Sloan-Kettering Cancer Center , New York , NY , USA.
authors: Florence
authors: F
authors: Huguet
authors: b Department of Radiation Oncology at Memorial Sloan-Kettering Cancer Center , New York , NY , USA.
authors: Carla
authors: C
authors: Hajj
authors: c Department of Radiology at Memorial Sloan-Kettering Cancer Center , New York , NY , USA.
authors: Corrine B
authors: CB
authors: Winston
authors: d Department of Biostatistics at Memorial Sloan-Kettering Cancer Center , New York , NY , USA.
authors: Weiji
authors: W
authors: Shi
authors: d Department of Biostatistics at Memorial Sloan-Kettering Cancer Center , New York , NY , USA.
authors: Zhigang
authors: Z
authors: Zhang
authors: b Department of Radiation Oncology at Memorial Sloan-Kettering Cancer Center , New York , NY , USA.
authors: Abraham J
authors: AJ
authors: Wu
authors: e Department of Medical Oncology at Memorial Sloan-Kettering Cancer Center , New York , NY , USA.
authors: Eileen M
authors: EM
authors: O'Reilly
authors: e Department of Medical Oncology at Memorial Sloan-Kettering Cancer Center , New York , NY , USA.
authors: Diane L
authors: DL
authors: Reidy
authors: f Department of Surgery at Memorial Sloan-Kettering Cancer Center , New York , NY , USA.
authors: Peter
authors: P
authors: Allen
authors: g Department of Radiation Oncology , University of Colorado School of Medicine , Aurora , CO , USA.
authors: Karyn A
authors: KA
authors: Goodman
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000706:statistics & numerical data*; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D016019:Survival Analysis