Records of 108 patients treated with concurrent external beam radiotherapy (EBRT) and GEM were reviewed. The median dose of EBRT in all 108 patients was 50.4 Gy (range, 3.6-60.8 Gy), usually administered in conventional fractionations (1.8-2 Gy/day). During radiotherapy, most patients received GEM at a dosage of 250 to 350 mg/m2 intravenously weekly for approximately 6 weeks. After CCRT, 59 patients (54.6 % ) were treated with adjuvant chemotherapy (AC), mainly with GEM. The median follow-up for all 108 patients was 11.0 months (range, 0.4-37.9 months).
Initial responses after CCRT for 85 patients were partial response: 26 patients, no change: 51 patients and progressive disease: 8 patients. Local progression was observed in 35 patients (32.4 % ), and the 2-year local control (LC) rate in all patients was 41.9 % . Patients treated with total doses of 50 Gy or more had significantly more favorable LC rates (2-year LC rate, 42.9 % ) than patients treated with total doses of less than 50 Gy (2-year LC rate, 29.6 % ). Regional lymph node recurrence was found in only 1 patient, and none of the 57 patients with clinical N0 disease had regional lymph node recurrence. The 2-year overall survival (OS) rate and the median survival time in all patients were 23.5 % and 11.6 months, respectively. Patients treated with AC had significantly more favorable OS rates (2-year OS, 31.8 % ) than those treated without AC (2-year OS, 12.4 % ; p < 0.0001). On multivariate analysis, AC use and clinical T stage were significant prognostic factors for OS.
CCRT using GEM yields a relatively favorable LC rate for unresectable pancreatic adenocarcinoma, and CCRT with AC conferred a survival benefit compared to CCRT without AC.