Prognostic Impact of CA 19-9 on Outcome after Neoadjuvant Chemoradiation in Patients with Locally Advanced Pancreatic Cancer
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To asses the impact of CA 19-9 and weight loss/gain on outcome after neoadjuvant chemoradiation (CRT) in patients with locally advanced pancreatic cancer (LAPC).
We analyzed 289 patients with LAPC treated with CRT for LAPC. All patients received concomitant chemotherapy parallel to radiotherapy and adjuvant treatments. CA 19-9 and body weight were collected as prognostic and predictive markers. All patients were included into a regular follow-up with reassessment of resectability.
Median overall survival in all patients was 14 months. Actuarial overall survival was 37 % at 12 months, 12 % at 24 months, and 4 % at 36 months. Secondary resectability was achieved in 35 % of the patients. R0/R1 resection was significantly associated with increase in overall survival (p = 0.04). Intraoperative radiotherapy was applied in 50 patients, but it did not influence overall survival (p = 0.05). Pretreatment CA 19-9 significantly influenced overall survival using different cutoff values. With increase in CA 19-9 levels, the possibility of secondary surgical resection decreased from 46 % in patients with CA 19-9 levels below 90 U/ml to 31 % in the group with CA 19-9 levels higher than 269 U/ml.
This large group of patients with LAPC treated with neoadjuvant CRT confirms that CA 19-9 and body weight are strong predictive and prognostic factors of outcome. In the future, individual patient factors should be taken into account to tailor treatment.
- 3.Berger AC, Garcia M Jr, Hoffman JP, Regine WF, Abrams RA, Safran H, et al. Postresection CA 19-9 predicts overall survival in patients with pancreatic cancer treated with adjuvant chemoradiation: a prospective validation by RTOG 9704. J Clin Oncol. 2008;26:5918–22.PubMedCentralPubMedCrossRefGoogle Scholar
- 6.Bauer TM, El Rayes BF, Li X, Hammad N, Philip PA, Shields AF, et al. Carbohydrate antigen 19-9 is a prognostic and predictive biomarker in patients with advanced pancreatic cancer who receive gemcitabine-containing chemotherapy: a pooled analysis of 6 prospective trials. Cancer. 2013;119:285–92.PubMedCrossRefGoogle Scholar
- 17.Krempien R, Muenter MW, Huber PE, Nill S, Friess H, Timke C, et al. Randomized phase II–study evaluating EGFR targeting therapy with cetuximab in combination with radiotherapy and chemotherapy for patients with locally advanced pancreatic cancer—PARC: study protocol [ISRCTN56652283]. BMC Cancer. 2005;5:131.PubMedCentralPubMedCrossRefGoogle Scholar
- 18.Combs SE, Habermehl D, Kessel K, Bergmann F, Werner J, Brecht IG, et al. Intensity modulated radiotherapy (IMRT) for the treatment of patients with locally advanced pancreatic cancer as neoadjuvant chemoradiation: outcome analysis and comparison with a 3D-treated patient cohort. Strahlenther Onkol. 2013;189:738–44.Google Scholar
- 19.Roeder F, Timke C, Uhl M, Habl G, Hensley FW, Buechler MW, et al. Aggressive local treatment containing intraoperative radiation therapy (IORT) for patients with isolated local recurrences of pancreatic cancer: a retrospective analysis. BMC Cancer. 2012;12:295.PubMedCentralPubMedCrossRefGoogle Scholar
- 21.Habermehl D, Lindel K, Rieken S, Haase K, Goeppert B, Buchler MW, et al. Chemoradiation in patients with unresectable extrahepatic and hilar cholangiocarcinoma or at high risk for disease recurrence after resection: analysis of treatment efficacy and failure in patients receiving postoperative or primary chemoradiation. Strahlenther Onkol. 2012;188:795–801.PubMedCrossRefGoogle Scholar
- 26.Vainshtein JM, Schipper M, Zalupski MM, Lawrence TS, Abrams R, Francis IR, et al. Prognostic significance of carbohydrate antigen 19-9 in unresectable locally advanced pancreatic cancer treated with dose-escalated intensity modulated radiation therapy and concurrent full-dose gemcitabine: analysis of a prospective phase 1/2 dose escalation study. Int J Radiat Oncol Biol Phys. 2013;86:96–101.PubMedCentralPubMedCrossRefGoogle Scholar
- 29.Kinsella TJ, Seo Y, Willis J, Stellato TA, Siegel CT, Harpp D, et al. The impact of resection margin status and postoperative CA19-9 levels on survival and patterns of recurrence after postoperative high-dose radiotherapy with 5-FU-based concurrent chemotherapy for resectable pancreatic cancer. Am J Clin Oncol. 2008;31:446–53.PubMedCrossRefGoogle Scholar