Gastrointestinal complications after concurrent chemoradiotherapy in locally advanced pancreatic cancer

Abstract

ObjectivesLocally advanced pancreatic cancer has a short survival of six to tenmonths. Chemoradiotherapy (CRT) is considered a treatment of choice.There is little information about the gastrointestinal toxicities of CRT inpancreatic cancer. Clinical features of gastrointestinal toxicities inpatients with locally advanced pancreatic cancer underwent CRT and theeffect of gastrointestinal toxicities on survival were investigated.MethodsPatients enrolled in this study had received concurrent CRT forpathologically proven locally advanced pancreatic cancer. Their medicalrecords were retrospectively analyzed.ResultsOne hundred fifty-six cases with locally advanced pancreatic cancerbetween August 2005 and March 2009 were enrolled (Table 1). Themedian age was 65 years and male patients 61.5%. The chemotherapyincluded 5-FU-based regimen (30.8%), gemcitabine-based regimen(59.6%), and 5-FU/gemcitabine-based regimen (9.6%). The deliveredradiotherapy modalities included 3D conformal radiotherapy (76.3%) andintensity-modulated radiotherapy (23.7%). The median follow-up periodfrom the start of CRT was 13.2 months (2-52.2 months). Gastrointestinal2toxicities are summarized in Table 2; Abdominal pain or dyspepsiadeveloped in 30 patients and nausea/vomiting in 4 patients with grade 1-2toxicity. There were two patients with anorexia with greater than grade 3toxicity. Fifty-three patients had significant complications such as gastriculcer (n=26), duodenal ulcer (n=17), radiation gastritis (n=17), andradiation duodenitis (n=5). Forty patients had upper gastrointestinalbleeding, such as hematemesis and melena. Eight patients were dead dueto uncontrolled bleeding. The median onset time of gastrointestinalcomplication was 5.2 months (0.8-50.8 months). Acute gastrointestinalcomplications (less than 90 days) occurred in 13 patients (24.5%) andlate complications (more than 90 days) in 40 patients (75.5%). Thelocation of the tumor (body, P=0.033) and chemotherapy regimen(5-FU+gemcitabine, P=0.015) were related with the risk factors ofgastrointestinal complications. The median overall survival was 13.1months in the non-gastrointestinal complication group and 14.0 monthsin the gastrointestinal complication group.ConclusionsGastrointestinal bleeding after CRT does not reduce survival of patientswith LAPC. However, gastrointestinal complications are common, andbleeding is highly prevalent and may be fatal. Further investigation isneeded to reduce serious radiation-induced gastrointestinalcomplications.