Dose escalation in locally advanced pancreatic cancer patients receiving chemoradiotherapy

Purpose: To investigate whether radiotherapy (RT) dose escalation would improve treatment outcomes without increasing severe toxicity in locally advanced pancreatic cancer patients. Methods: From 2005 to 2015, 497 locally advanced pancreatic cancer patients who received neoadjuvant or definitive chemoradiotherapy (CCRT) were included. Patients were divided according to the total dose (TD). Overall survival (OS), progression-free survival (PFS), local failure-free rate (LFFR), distant failure free rate (DFFR), and toxicity rates were compared between <61 Gy (n = 345) and >= 61 Gy groups (n = 152). Additionally, propensity score matching was performed. Results: At a median follow-up of 19.3 months (range, 4.8-128.5 months), the 1-year OS, PFS, LFFR, and DFFR were significantly higher in the >= 61 Gy group. After multivariate analysis, a TD of >= 61 Gy remained a significant favorable factor for OS (p = 0.019), PFS (p = 0.001), LFFR (p = 0.004), and DFFR (p = 0.008). After propensity score matching, the >= 61 Gy group still showed higher OS, PFS, and LFFR, but not DFFR (p = 0.205). The acute and late toxicity rates showed no significant difference between the two groups. Conclusion: Patients who received a higher RT dose showed not only improved PFS and LFFR, but also improved OS without an increase in severe toxicity. Dose-escalated CCRT can be a favorable treatment option in locally advanced pancreatic cancer patients. (C) 2017 Elsevier B.V. All rights reserved.