title: Outcome Analysis of Chemoradiation in Unresectable Pancreatic Cancer Focusing on Treatment Sequencing Strategy.
abstract: To analyze the outcomes of patients with unresectable pancreatic cancer after chemoradiotherapy (CCRT), focusing on sequencing strategy.
  
  
  
  Data of 144 patients treated from January 1989 to December 2013 were retrospectively analyzed. Patients were divided into the scheduled group (N=27), salvage group (N=37) and upfront group (N=80) per CCRT and chemotherapy sequence.
  
  
  
  With a median follow-up of 10.4 months (range=1.4-164.2), median overall survival (OS) was 13.5 months. Patients in the upfront group had inferior performance status and received a lower radiation dose (p=0.007 and p<0.001, respectively). Higher radiation dose (≥45 Gy) was the sole prognosticator related with improved survival in multivariate (p=0.001) analysis, whereas treatment sequence was not a significant prognostic factor (p=0.409).
  
  
  
  No difference was found among tested sequencing strategies that were all well-tolerated, despite skewed distribution for performance and radiation dose. An upfront approach may be a viable option for patients with limited performance to undergo more active systemic chemotherapy.
authors: Department of Radiation Oncology, Konkuk Medical Center, Seoul, Republic of Korea.
authors: Hyeon Kang
authors: HK
authors: Koh
authors: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea ekchie93@snu.ac.kr.|Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.
authors: Eui Kyu
authors: EK
authors: Chie
authors: Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
authors: Kyubo
authors: K
authors: Kim
authors: Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Jin-Young
authors: JY
authors: Jang
authors: Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Sun Whe
authors: SW
authors: Kim
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: DO-Youn
authors: DY
authors: Oh
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Seock-Ah
authors: SA
authors: Im
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Yung-Jue
authors: YJ
authors: Bang
authors: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.|Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.
authors: Sung W
authors: SW
authors: Ha
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Pancreatic cancer; chemoradiotherapy; chemotherapy; radiation dose