radiotherapy-pancreatic cancer

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2. ( / ) / / 3. Five-year Relative Survival (%)* during Three Time Periods By Cancer Site *5-year relative survival rates based on follow up of patients through 2003. Recent changes in classification of ovarian cancer have affected 1996-2002 survival rates. Source: Surveillance, Epidemiology, and End Results Program, 1975-2003, Division of Cancer Control and Population Sciences, National Cancer Institute, 2006. Site 1975-1977 1984-1986 1996-2002 All sites 50 53 66 Breast (female) 75 79 89 Colon 51 59 65 Leukemia 35 42 49 Lung and bronchus 13 13 16 Melanoma 82 86 92 Non-Hodgkin lymphoma 48 53 63 Ovary 37 40 45 Pancreas 2 3 5 Prostate 69 76 100 Rectum 49 57 66 Urinary bladder 73 78 82 4. : 20% 40% 40% 5. (Staleys , 1996) [1] / 15--20 5-20% 6-10 0% 3-6 0% ] Staley CA, et al. Pancreas 1996; 12:373-80. 5- (%) 6. , : 15-20 ) - 2% (adjuvant) (neoadjuvant) . 7. Patterns of Failure after Surgery After surgery local relapse rate of 50 86% and distant recurrence rate of 40 90% 8. Select between Observation Chemotherapy Chemoradiation Radiotherapy Anything else to improve the patients outcome? 15 $1 MILLION 14 $500.000 13 $250.000 12 $100.000 11 $50.000 10 $25.000 9 $16.000 8 $8.000 7 $4.000 6 $2.000 5 $1.000 4 $500 3 $300 2 $200 1 $100 9. Study (Year) Number of Patients Enrolled Patients with R1 Resection (%) Treatment Assignment Median Survival Months Treatment Assignment Median Survival Months p value GITSG (1985) 49 0 5-FU-based Chemoradiation 21.0 Observation 10.9 0.035 EORTC 40891 (1999) 114* 21 5-FU-based Chemoradiation 17.1 Observation 12.6 0.09 ESPAC-1 (2004) 289 18 5-FU/Leucovorin Chemotherapy 20.1 No Chemotherapy 15.5 0.009 5-FU-based Chemoradiation 15.9 No Chemoradiation 17.9 0.05 RTOG 9704 (2006) 388 (Head lesions) 34 Unknown in 25% Gemcitabine then 5-FU/EBRT then Gemcitabine 20.5 5-FU then 5-FU/EBRT then 5-FU 16.9 0.09 CONKO 001 (2007) 368 19 Gemcitabine 22.8 Observation 20.2 0.005 DFS = 13.4 DFS = 6.9 < 0.001 Randomized Trials of Adjuvant Therapy 10. Entry Criteria Quality Assurance of Radiation Therapy Performed RTOG 9704 / US Intergroup Phase III Postop Adjuvant Study *First Phase III Adjuvant Pancreas Trial to Do So 11. trial RTOG 97-04 RT QA 12. EORTC-40013-22012/FFCD-9203/GERCOR phase II study ; 13. Post-operative 5-FU-based Chemoradiation (CXRT) for resected pancreatic cancer non-randomized trials Institution Time Period # Patients Median survival CXRT Median survival No CXRT P- value Mayo Clinic 1975- 2005 466 (R0) 25.2 Mo 19.2 Mo 0.001 Johns Hopkins Hospital 1993- 2005 616 (R0 + R1) 21.4 Mo 14.4 Mo 2 week break SBRT 6.6 Gy x 5 Mon-Fri Gemcitabine Chemotherapy (3 wks on, 1 wk off) Until toxicity or progression Primary endpoint: Late GI Toxicity > 4 months Secondary: Tumor Progression Free Survival N=60 Trial open at Stanford and Johns Hopkins. Memorial Sloan Kettering Pending. Phase II Multi-Institutional Study of Stereotactic Body Radiation Therapy for Unresectable Panceatic Cancer 34. HDR-IORT: Pancreas

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