Abstract：Objective To retrospectively analyze the relationship between patterns of local recurrence and radiotherapy target dose after adjuvant radiotherapy for the pancreatic ductal adenocarcinoma(PDAC), aiming to provide reference for exploring reasonable target and dosage. Methods Clinical data of 138 patients with T1-4N0-2M0 PDAC who underwent adjuvant radiotherapy after radical resection from April 2012 to December 2020 were analyzed retrospectively. The influencing factors of local recurrence and the correlation between local recurrence site and radiotherapy target dose were analyzed. Results The median follow-up time was 37.2 months. The median overall survival (mOS) was 29.9 months. The 5-year OS rate was 27.4%. And the median progression-free survival (mPFS) was 13.9 months. There were 24 cases of local recurrence (17.4%), and 10 cases of local recurrence complicated with distant metastasis (7.2%). The correlation between local recurrence site and radiotherapy target dose could be evaluated in 19 patients with complete clinical data. The first local recurrence occurred near the para-aortic (Ao), the celiac axis (CA) and the superior mesenteric artery (SMA) were 8, 5 and 4 cases, respectively. The radiotherapy doses of 8 patients with local recurrence only in the PTV field were above 45 Gy. There were 8 cases of local recurrence both in and out of the PTV field, including 3 cases with dose line between 40 and 52 Gy, 2 cases with dose line between 20 and 47.5 Gy, and 3 cases with dose line between 0.5 and 52.5 Gy. There were 3 cases of local recurrence out of the PTV field, and the dose line ranged from 0 to 20 Gy. Conclusions The local recurrence rate of PDAC after radical surgery combined with postoperative radiotherapy is low, but a small number of patients have recurrence in the high-dose range of radiation field and regional recurrence out of the field. For these patients, it may be necessary to explore a more appropriate target dose and range for adjuvant radiotherapy.
Yang Weifang,Ouyang Yuxiu,Li Tingting et al. Relationship between patterns of local recurrence and radiotherapy target dose after postoperative adjuvant radiotherapy for pancreatic cancer[J]. Chinese Journal of Radiation Oncology, 2022, 31(11): 1011-1016.
[1] Siegel RL, Miller KD, Fuchs HE, et al.Cancer statistics, 2021[J]. CA Cancer J Clin, 2021,71(1):7-33. DOI: 10.3322/caac.21654. [2] Chen W, Zheng R, Baade PD, et al.Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016,66(2):115-132. DOI: 10.3322/caac.21338. [3] Rahib L, Smith BD, Aizenberg R, et al.Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States[J]. Cancer Res, 2014,74(11):2913-2921. DOI: 10.1158/0008-5472.CAN-14-0155. [4] 陈力宁, 唐源, 金晶. 局限期胰腺癌放化疗的临床试验研究进展[J].中华放射肿瘤学杂志,2021,30(12):1326-1329. DOI: 10.3760/cma.j.cn113030-20200407-00165. Chen LN, Tang Y, Jin J.Research progress on clinical trials of radiaotherapy and chemotherapy in localized pancreatic cancer[J]. Chin J Radiat Oncol, 2021,30(12):1326-1329. DOI: 10.3760/cma.j.cn113030-20200407-00165. [5] Dholakia AS, Kumar R, Raman SP, et al.Mapping patterns of local recurrence after pancreaticoduodenectomy for pancreatic adenocarcinoma: a new approach to adjuvant radiation field design[J]. Int J Radiat Oncol Biol Phys, 2013,87(5):1007-1015. DOI: 10.1016/j.ijrobp.2013.09.005. [6] 吴莉莉, 许耀麟, 楼文晖. 放射治疗在胰腺癌治疗中的应用现状和展望[J].外科理论与实践,2022,27(1):25-29. DOI: 10.16139/j.1007-9610.2022.01.007. Wu LL, Xu YL, Lou WH.Current status and prospect of radiotherapy in the treatment of pancreatic cancer[J]. J Surg Theory Pract,2022,27(1):25-29. DOI: 10.16139/j.1007-9610. 2022.01.007. [7] Wu LL, Xu YL, Zeng ZC, et al.Efficacy and safety of S-1 based adjuvant chemoradiotherapy for resected pancreatic ductal adenocarcinoma with high-risk pathological feature: a prospective, single-arm, interventional study[J]. J Pancreatol, 2022(1):18-26. DOI: 10.1097/JP9.0000000000000084. [8] 林根来, 曾昭冲, 吴铮, 等. 胰腺癌根治术与术后辅助外放疗的疗效比较[J].中华肿瘤杂志,2009,31(4):308-311. DOI: 10.3760/cma.j.issn.0253-3766.2009.04.019. Lin GL, Zeng ZC, Wu Z, et al.Postoperative adjuvant radiotherapy for pancreatic carcinoma patients after radical resection[J]. Chin J Oncol, 2009,31(4):308-311. DOI: 10.3760/cma.j.issn.0253-3766.2009.04.019. [9] Goodman KA, Regine WF, Dawson LA, et al.Radiation therapy oncology group consensus panel guidelines for the delineation of the clinical target volume in the postoperative treatment of pancreatic head cancer[J]. Int J Radiat Oncol Biol Phys, 2012,83(3):901-908. DOI: 10.1016/j.ijrobp.2012.01.022. [10] Kalser MH, Ellenberg SS.Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection[J]. Arch Surg, 1985,120(8):899-903. DOI: 10.1001/archsurg.1985.01390320023003. [11] Neoptolemos JP, Stocken DD, Friess H, et al.A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer[J]. N Engl J Med, 2004,350(12):1200-1210. DOI: 10.1056/NEJMoa032295. [12] Smeenk HG, van Eijck CH, Hop WC, et al. Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891[J]. Ann Surg, 2007,246(5):734-740. DOI: 10.1097/SLA.0b013e318156eef3. [13] Morganti AG, Cellini F, Buwenge M, et al.Adjuvant chemoradiation in pancreatic cancer: impact of radiotherapy dose on survival[J]. BMC Cancer, 2019,19(1):569. DOI: 10.1186/s12885-019-5790-2. [14] Hall WA, Colbert LE, Liu Y, et al.The influence of adjuvant radiotherapy dose on overall survival in patients with resected pancreatic adenocarcinoma[J]. Cancer, 2013,119(12):2350-2357. DOI: 10.1002/cncr.28047. [15] Van Laethem JL, Hammel P, Mornex F, et al.Adjuvant gemcitabine alone versus gemcitabine-based chemoradiotherapy after curative resection for pancreatic cancer: a randomized EORTC-40013-22012/FFCD-9203/GERCOR phase II study[J]. J Clin Oncol, 2010,28(29):4450-4456. DOI: 10.1200/JCO.2010.30.3446. [16] Regine WF, Winter KA, Abrams R, et al.Fluorouracil-based chemoradiation with either gemcitabine or fluorouracil chemotherapy after resection of pancreatic adenocarcinoma: 5-year analysis of the U.S. intergroup/RTOG 9704 phase III trial[J]. Ann Surg Oncol, 2011,18(5):1319-1326. DOI: 10.1245/s10434-011-1630-6. [17] Pen SL, Shan YS, Hsiao CF, et al.High expression of krüppel-like factor 10 or Smad4 predicts clinical benefit of adjuvant chemoradiotherapy in curatively resected pancreatic adenocarcinoma: from a randomized phase III trial[J]. Radiother Oncol, 2021,158:146-154. DOI: 10.1016/j.radonc.2021.02.037. [18] Kamarajah SK, Sonnenday CJ, Cho CS, et al.Association of adjuvant radiotherapy with survival after margin-negative resection of pancreatic ductal adenocarcinoma: a propensity-matched national cancer database (NCDB) analysis[J]. Ann Surg, 2021,273(3):587-594. DOI: 10.1097/SLA.0000000000003242. [19] Yu W, Hu W, Shui Y, et al.Pancreatic cancer adjuvant radiotherapy target volume design: based on the postoperative local recurrence spatial location[J]. Radiat Oncol, 2016,11(1):138. DOI: 10.1186/s13014-016-0714-7. [20] Arcelli A, Bertini F, Strolin S, et al. Definition of local recurrence site in resected pancreatic adenocarcinoma: a multicenter study (DOLORES-1)[J]. Cancers (Basel), 2021,13(12)DOI: 10.3390/cancers13123051.
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