Carbon ion therapy for patients with localized, resectable adenocarcinoma of the pancreas
Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract
2005 Gastrointestinal Cancers Symposium
Session Type and Session Title:
Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract - General Poster Session
S. Yamada, H. Kato, K. Yamaguchi, H. Kitabayashi, H. Tsujii, H. Saisyo, Working group for the pancreas cancer
We examined the effect of preoperative carbon ion therapy in terms of reducing the rate of local recurrence in patients undergoing resection for adenocarcinoma of the pancreas and then reducing treatment period by using biological properties of high-LET radiations.
Between April 2000 and August 2004, 31 patients judged at the clinical stages I,II or III were enrolled into this trial. Criteria for trial eligibility were confirmation of ductal carcinoma by CT findings. Carbon beams of 290, 350 and 400 MeV/nucleon energy were generated in the HIMAC synchrotron. Carbon ion therapy was given once daily, 4days a week, for 16 fractions in 4 weeks or 8 fractions in 2 weeks. The dose was set to 44.8GyE(2.8GyE per fraction) and escalated to 48.0GyE at 5% increments for 16 fractions or 30.0GyE(3.75 GyE per fraction) and escalated to 33.2GyE for 8 fractions. The target volume included gross tumor and regional pancreatic draining lymph nodes. Toxicity on organs such as the skin and digestive tracts was assessed according to the NCI-CTC(acute) and RTOG/EOTRC(late) classification.
No grade 3 to 5 acute toxicity was observed. Two grade3 late reactions occurred among 12 of the patients treated with a dose of 48.0GyE. All of 2 reactions were portal vein stenoses after surgery. Of 31 patients, 21(68%) had resection. The pathologic response of the 19 resected specimens revealed evidence of grade 2 treatment effects with significant fibrosis, hyalinization, and necrosis (Pathological grade2 is defined as a less than 33% active cancer cells.). Remarkable antitumor effects were observed. The overall actual local control rates were 100% and 100% at 1 year and at 2 years of follow-up respectively. No local failure was observed in any of the 31 enrolled patients. The one year overall survival rate of all enrolled patients were 61.9%, and these of patients with resection were 90.1% . None of the patients who underwent resection had local and regional recurrences. All instances of failure were distant, and all of them were in the liver.
The above results suggest the superior usefulness of heavy ion radiotherapy in the treatment of pancreatic carcinoma to conventional photon radiotherapy.