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  • von Minckwitz G et al Clinical

    2022-09-17

    von Minckwitz, G., et al., 2008. Clinical response after two cycles compared to HER2, Ki-67, p53, and bcl-2 in independently predicting a pathological complete response after preoperative chemotherapy in patients with operable carcinoma of the breast. Breast Cancer Res. 10, R30. Wapinski, O., Chang, H.Y., 2011. Long noncoding RNAs and human disease. Trends Cell Biol. 21, 354–361. Wierzbicki, A.T., 2012. The role of long non-coding RNA in transcriptional gene silencing.
    Wong, M.W., et al., 2011. BRIP1, PALB2, and RAD51C L-Glutamine analysis reveals their relative importance as genetic susceptibility factors for breast cancer. Breast Cancer Res. Treat. 127, 853–859.
    Contents lists available at ScienceDirect
    Radiotherapy and Oncology
    Original Article
    Concurrent chemoradiotherapy using proton beams for unresectable locally advanced pancreatic cancer
    Yuichi Hiroshima ⇑, Nobuyoshi Fukumitsu, Takashi Saito, Haruko Numajiri, Keiko Nemoto Murofushi, Kayoko Ohnishi, Tetsuo Nonaka, Hitoshi Ishikawa, Toshiyuki Okumura, Hideyuki Sakurai
    Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
    Article history:
    Keywords:
    Pancreatic cancer
    Proton beam therapy
    Radiotherapy
    Chemotherapy 
    Background and purpose: We investigated clinical outcomes of proton beam concurrent chemoradiother-apy (CCRT) for unresectable, locally advanced pancreatic cancer (LAPC) patients.
    Materials and methods: Records from 42 unresectable LAPC patients (21 male and 21 female, 39–83 years old) with IIB/III clinical staging of 1/41 treated by proton beam CCRT were retrospectively reviewed. Twelve patients received a conventional 50 Gray equivalents (GyE) in 25 fractions protocol and 30 others received a higher dose protocol of 54.0–67.5 GyE in 25–33 fractions. Gemcitabine or S-1 (Tegafur, Gimeracil and Oteracil) was used concurrently. Toxicity, overall survival (OS) and local control (LC) were examined.
    Results: Acute adverse events of grades 1, 2, 3 and 4 were found in 4, 15, 17 and 2 patients, respectively. All grade 3 and 4 events were hematologic. Late adverse events of grades 1 and 2 were found in 3 and 2 patients, respectively. No late adverse effects of grade 3 or higher were observed. The 1-year/2-year OS rates from the start of CCRT were 77.8/50.8% with median survival time (MST) of 25.6 months. The 1-year/2-year LC rate from CCRT start was 83.3/78.9% with a median time to local recurrence of more than 36 months. Total irradiation dose was the only significant factor in univariate analyses of OS and LC (p = 0.015 and 0.023, respectively).
    Conclusion: Proton beam CCRT lengthened survival periods compared to previous photon CCRT data and higher dose irradiation prolonged LC and OS for unresectable LAPC patients. Proton beam therapy is therefore safe and effective in these cases.
    Pancreatic cancer carries a very poor prognosis and the number of deaths per year coelom causes has steadily risen to approximately 35,000 in 2013, making it the fourth leading cause of cancer deaths in Japan [1]. Surgical resection is currently the only curative treat-ment but less than 20% of cases are resectable at presentation and up to 25–30% of newly diagnosed patients with non-distant meta-static lesions are divided into borderline resectable and unre-sectable locally advanced pancreatic cancer (LAPC) patients based upon the extent of vascular involvement [2].
    In recent years, intensive chemotherapies such as FOLFIRINOX and a combination of gemcitabine (Gem) and nab-Paclitaxel have improved clinical outcomes of unresectable LAPC patients [3,4]; however, many patients have difficulty in continuous treatment due to serious incidences of adverse events [5,6]. Concurrent chemoradiotherapy (CCRT) is another treatment option for unre-