OPENPancreatic Cancer
Carbon ion radiotherapy for pancreatic cancer
Indications
Carbon ion radiotherapy is performed in the following cases.
| Disease | Indication | |
|---|---|---|
| 1 | Resectable/Borderline resectable pancreatic cancer (preoperative) | Clinical stage 0, I, II, or III resectable/borderline resectable pancreatic cancer |
| 2 | Locally advanced pancreatic cancer | Clinical stage I, II, or III primary pancreatic cancer in which the use of other curative treatments is difficult |
| 3 | Postoperative local recurrence of pancreatic cancer | Postoperative localized recurrent tumors |
*Stage IV may also be an indication in the case of localized paraaortic lymph node metastasis alone. Please refer to your primary physician for more information.
There are two regimens of carbon ion radiotherapy for pancreatic cancer depending on whether it is used in combination with surgery: (1) preoperative carbon ion radiotherapy (8 irradiations over 2 weeks) followed by planned surgery; and (2) curative carbon ion radiotherapy (12 irradiations over 3 weeks) in patients in whom surgery cannot be performed for reasons such as the extensiveness of the lesions. Carbon ion radiotherapy for postoperative local recurrence is performed in the same regimens. In either case, the treatment is not indicated if the patient's general condition would interfere with it, as in the following cases: (1) metastasis is present in an area such as the liver, lungs, peritoneum, or distant lymph nodes; (2) tumors have invaded the gastrointestinal tract; (3) a metal stent has been placed to treat jaundice (treatment possible with plastic stent); or (4) a serious complication is present.
Treatment record in QST hospital
1. Resectable pancreatic cancer
Preoperative carbon ion radiotherapy for pancreatic cancer was first performed in a clinical study that began in April 2003. In that study, 26 patients were treated with 8 irradiations over 2 weeks, and dose was increased from 30 GyE to 36.8 GyE. Favorable results were obtained in an analysis of the 21 patients who underwent resection: there were no patients with local recurrence, and the 5-year survival rate was 52%.*1
2. Locally advanced pancreatic cancer
Beginning in 2007, a phase I/II dose-escalation study of carbon ion radiotherapy combined with gemcitabine (GEM) was conducted in 72 patients with locally advanced pancreatic cancer. Although dose-limiting toxicity (DLT) was seen in 3 patients (4%), it consisted of only Grade 4 neutropenia in 2 patients and Grade 3 cholangitis in 1 patient. The results were favorable. In the 42 patients in the high-dose group who were irradiated at doses of ≥45.6 Gy (relative biological effectiveness: RBE), the 2-year survival rate and median survival time were 48% and 23.9 months, respectively.*2
The Japan Carbon-Ion Radiation Oncology Study Group (J-CROS) analyzed the results for 72 patients who underwent carbon ion radiotherapy at different institutions from 2012 to 2014. Hematotoxicity of Grade 3 or higher was seen as an adverse event in 19 patients, and the only non-hematotoxicity event seen was loss of appetite in 2 paitient.The 2-year survival rate and median survival time were 46% and 21.5 momths,vespectively*3
3. Postoperative local recurrence of pancreatic cancer
From January 2011 to March 2015, carbon ion radiotherapy was performed in 30 patients for postoperative local recurrence of pancreatic cancer. The only impairment of normal tissue seen was Grade 3 leukopenia in 2 patients. The results were favorable with the 2-year survival rate of 51%, the median survival time of 26 months, and the median postoperative survival time of 53 months.*4
*1 Shinoto M, et al. Cancer. 2013;119:45-51.
*2 Shinoto M, et al. Int J Radiat Oncol Biol Phys. 2016;95:498-504.
*3 Kawashiro S, et al. Int J Radiat Oncol Biol Phys. 2018;101:1212-1221.
*4 Kawashiro S, et al. Radiother Oncol. 2018;129:101-104.