Radiotherapy for locally advanced pancreatic adenocarcinoma at St. Luke’s Medical Center in the Philippines

Miriam Joy Calaguas, Carlos Dy, Michael Vincent Saniel. M.D

Objectives: Patients with locally advanced pancreatic malignancies are known to have poor prognosis. If untreated, 6 months survival is expected. Options available include chemotherapy and/ or radiotherapy. This retrospective study seeks to examine the survival time of patients with biopsy?proven pancreatic adenocarcinoma of the pancreatic head, who underwent abdominal irradiation at the St. Luke’s Medical Center Quezon City.

Methods: The medical records of locally advanced pancreatic cancer patients who initiated radiation therapy (RT) at our institution from 2003 to 2010, with or without chemotherapy (5?fluorouracil or gemcitabine), and with or without bypass surgery were reviewed. The median survival was recorded using the date of RT day 1 to the date of death or April 30, 2011 if still living. Irradiation to the tumor and regional lymph nodal groups was delivered via either AP/PA parallel opposed fields with cord block or intensity modulated radiation therapy (IMRT) to total dose 40 to 60 Gy in 22 to 34 fractions.

Results: The data of 13 patients who underwent radiotherapy for locally advanced adenocarcinoma of the pancreatic head were analyzed. 2 of the 13 (15%) had no treatment interruptions. 6 (46%) were able to complete the course of RT to the prescribed dose. Eight (61%) underwent IMRT; two?field techniques were used for the five remaining patients. Five (38%) had bypass surgeries. Seven (54%) had chemotherapy. The median overall survival was 254 days, about 8.5 months. (2 living patients were censored.)

Conclusion: The results showed that the outcome of treatment in our institution is consistent with that of internationally published data on treated locally advanced pancreatic adenocarcinoma (with OS ranges: 5.3 to 11.4 months).