Multi-institutional Study of Carbon-ion Radiotherapy for Locally Advanced Pancreatic Cancer: Japan Carbon-ion Radiation Oncology Study Group (J-CROS) Study 1403 Pancreas

Shohei Kawashiro, Shigeru Yamada, Masahiko Okamoto, Tatsuya Ohno, Takashi Nakano, Makoto Shinoto, Yoshiyuki Shioyama, Kenji Nemoto, Yuka Isozaki, Hiroshi Tsuji, Tadashi Kamada

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Abstract

Purpose: The aim of this multi-institutional study was to evaluate the efficacy and safety of carbon-ion radiotherapy (C-ion RT) for locally advanced pancreatic cancer (LAPC). Methods and Materials: Patients with LAPC treated with C-ion RT from April 2012 to December 2014 at 3 institutions were retrospectively analyzed. Patients with pathologically-confirmed invasive ductal adenocarcinoma of the pancreas were eligible. The prescribed dose was 52.8 Gy (relative biological effectiveness weighted absorbed dose; RBE) or 55.2 Gy (RBE) in 12 fractions. Overall survival (OS), distant metastasis-free survival (DMFS), local recurrence (LR), and toxicity were evaluated. Results: In total, 72 patients were included in this study. Tumors in the head of the pancreas were seen in 30 patients (42%), while those in the body or tail of the pancreas were seen in 42 patients (58%). Fifty-six patients (78%) received concurrent chemotherapy. The OS rates were 73% (95% confidence interval [CI], 62%-84%) at 1 year, and 46% (95% CI, 31%-61%) at 2 years with a median OS of 21.5 months (95% CI, 11.8-31.2 months). The 1- and 2-year DMFS rates were 41% (95% CI, 29%-52%) and 28% (95% CI, 16%-40%), respectively. The 1- and 2-year cumulative incidences of LR were 16% (95% CI, 9%-26%) and 24% (95% CI, 14%-36%), respectively. Nineteen patients (26%) experienced acute grade 3 or 4 hematological toxicities. Two patients (3%) had grade 3 anorexia. Late gastrointestinal (GI) grade 3 toxicity was observed in 1 patient (1%). No patients developed late grade 4 or 5 toxicity. Conclusions: The first multi-institutional analysis of C-ion RT for LAPC indicated relatively favorable outcomes with limited toxicities, especially for tumors not in close proximity to GI tract.

Original languageEnglish
Pages (from-to)1212-1221
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Volume101
Issue number5
DOIs
Publication statusPublished - Aug 1 2018

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Heavy Ion Radiotherapy
pancreas
Radiation Oncology
Pancreatic Neoplasms
Pancreas
radiation therapy
Japan
Carbon
cancer
Ions
confidence
carbon
radiation
Confidence Intervals
toxicity
intervals
ions
grade
metastasis
Survival

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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Multi-institutional Study of Carbon-ion Radiotherapy for Locally Advanced Pancreatic Cancer : Japan Carbon-ion Radiation Oncology Study Group (J-CROS) Study 1403 Pancreas. / Kawashiro, Shohei; Yamada, Shigeru; Okamoto, Masahiko; Ohno, Tatsuya; Nakano, Takashi; Shinoto, Makoto; Shioyama, Yoshiyuki; Nemoto, Kenji; Isozaki, Yuka; Tsuji, Hiroshi; Kamada, Tadashi.

In: International Journal of Radiation Oncology Biology Physics, Vol. 101, No. 5, 01.08.2018, p. 1212-1221.

Research output: Contribution to journalArticle

Kawashiro, Shohei ; Yamada, Shigeru ; Okamoto, Masahiko ; Ohno, Tatsuya ; Nakano, Takashi ; Shinoto, Makoto ; Shioyama, Yoshiyuki ; Nemoto, Kenji ; Isozaki, Yuka ; Tsuji, Hiroshi ; Kamada, Tadashi. / Multi-institutional Study of Carbon-ion Radiotherapy for Locally Advanced Pancreatic Cancer : Japan Carbon-ion Radiation Oncology Study Group (J-CROS) Study 1403 Pancreas. In: International Journal of Radiation Oncology Biology Physics. 2018 ; Vol. 101, No. 5. pp. 1212-1221.
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abstract = "Purpose: The aim of this multi-institutional study was to evaluate the efficacy and safety of carbon-ion radiotherapy (C-ion RT) for locally advanced pancreatic cancer (LAPC). Methods and Materials: Patients with LAPC treated with C-ion RT from April 2012 to December 2014 at 3 institutions were retrospectively analyzed. Patients with pathologically-confirmed invasive ductal adenocarcinoma of the pancreas were eligible. The prescribed dose was 52.8 Gy (relative biological effectiveness weighted absorbed dose; RBE) or 55.2 Gy (RBE) in 12 fractions. Overall survival (OS), distant metastasis-free survival (DMFS), local recurrence (LR), and toxicity were evaluated. Results: In total, 72 patients were included in this study. Tumors in the head of the pancreas were seen in 30 patients (42{\%}), while those in the body or tail of the pancreas were seen in 42 patients (58{\%}). Fifty-six patients (78{\%}) received concurrent chemotherapy. The OS rates were 73{\%} (95{\%} confidence interval [CI], 62{\%}-84{\%}) at 1 year, and 46{\%} (95{\%} CI, 31{\%}-61{\%}) at 2 years with a median OS of 21.5 months (95{\%} CI, 11.8-31.2 months). The 1- and 2-year DMFS rates were 41{\%} (95{\%} CI, 29{\%}-52{\%}) and 28{\%} (95{\%} CI, 16{\%}-40{\%}), respectively. The 1- and 2-year cumulative incidences of LR were 16{\%} (95{\%} CI, 9{\%}-26{\%}) and 24{\%} (95{\%} CI, 14{\%}-36{\%}), respectively. Nineteen patients (26{\%}) experienced acute grade 3 or 4 hematological toxicities. Two patients (3{\%}) had grade 3 anorexia. Late gastrointestinal (GI) grade 3 toxicity was observed in 1 patient (1{\%}). No patients developed late grade 4 or 5 toxicity. Conclusions: The first multi-institutional analysis of C-ion RT for LAPC indicated relatively favorable outcomes with limited toxicities, especially for tumors not in close proximity to GI tract.",
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T1 - Multi-institutional Study of Carbon-ion Radiotherapy for Locally Advanced Pancreatic Cancer

T2 - Japan Carbon-ion Radiation Oncology Study Group (J-CROS) Study 1403 Pancreas

AU - Kawashiro, Shohei

AU - Yamada, Shigeru

AU - Okamoto, Masahiko

AU - Ohno, Tatsuya

AU - Nakano, Takashi

AU - Shinoto, Makoto

AU - Shioyama, Yoshiyuki

AU - Nemoto, Kenji

AU - Isozaki, Yuka

AU - Tsuji, Hiroshi

AU - Kamada, Tadashi

PY - 2018/8/1

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N2 - Purpose: The aim of this multi-institutional study was to evaluate the efficacy and safety of carbon-ion radiotherapy (C-ion RT) for locally advanced pancreatic cancer (LAPC). Methods and Materials: Patients with LAPC treated with C-ion RT from April 2012 to December 2014 at 3 institutions were retrospectively analyzed. Patients with pathologically-confirmed invasive ductal adenocarcinoma of the pancreas were eligible. The prescribed dose was 52.8 Gy (relative biological effectiveness weighted absorbed dose; RBE) or 55.2 Gy (RBE) in 12 fractions. Overall survival (OS), distant metastasis-free survival (DMFS), local recurrence (LR), and toxicity were evaluated. Results: In total, 72 patients were included in this study. Tumors in the head of the pancreas were seen in 30 patients (42%), while those in the body or tail of the pancreas were seen in 42 patients (58%). Fifty-six patients (78%) received concurrent chemotherapy. The OS rates were 73% (95% confidence interval [CI], 62%-84%) at 1 year, and 46% (95% CI, 31%-61%) at 2 years with a median OS of 21.5 months (95% CI, 11.8-31.2 months). The 1- and 2-year DMFS rates were 41% (95% CI, 29%-52%) and 28% (95% CI, 16%-40%), respectively. The 1- and 2-year cumulative incidences of LR were 16% (95% CI, 9%-26%) and 24% (95% CI, 14%-36%), respectively. Nineteen patients (26%) experienced acute grade 3 or 4 hematological toxicities. Two patients (3%) had grade 3 anorexia. Late gastrointestinal (GI) grade 3 toxicity was observed in 1 patient (1%). No patients developed late grade 4 or 5 toxicity. Conclusions: The first multi-institutional analysis of C-ion RT for LAPC indicated relatively favorable outcomes with limited toxicities, especially for tumors not in close proximity to GI tract.

AB - Purpose: The aim of this multi-institutional study was to evaluate the efficacy and safety of carbon-ion radiotherapy (C-ion RT) for locally advanced pancreatic cancer (LAPC). Methods and Materials: Patients with LAPC treated with C-ion RT from April 2012 to December 2014 at 3 institutions were retrospectively analyzed. Patients with pathologically-confirmed invasive ductal adenocarcinoma of the pancreas were eligible. The prescribed dose was 52.8 Gy (relative biological effectiveness weighted absorbed dose; RBE) or 55.2 Gy (RBE) in 12 fractions. Overall survival (OS), distant metastasis-free survival (DMFS), local recurrence (LR), and toxicity were evaluated. Results: In total, 72 patients were included in this study. Tumors in the head of the pancreas were seen in 30 patients (42%), while those in the body or tail of the pancreas were seen in 42 patients (58%). Fifty-six patients (78%) received concurrent chemotherapy. The OS rates were 73% (95% confidence interval [CI], 62%-84%) at 1 year, and 46% (95% CI, 31%-61%) at 2 years with a median OS of 21.5 months (95% CI, 11.8-31.2 months). The 1- and 2-year DMFS rates were 41% (95% CI, 29%-52%) and 28% (95% CI, 16%-40%), respectively. The 1- and 2-year cumulative incidences of LR were 16% (95% CI, 9%-26%) and 24% (95% CI, 14%-36%), respectively. Nineteen patients (26%) experienced acute grade 3 or 4 hematological toxicities. Two patients (3%) had grade 3 anorexia. Late gastrointestinal (GI) grade 3 toxicity was observed in 1 patient (1%). No patients developed late grade 4 or 5 toxicity. Conclusions: The first multi-institutional analysis of C-ion RT for LAPC indicated relatively favorable outcomes with limited toxicities, especially for tumors not in close proximity to GI tract.

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