Locally advanced pancreatic cancer (LAPC) is currently treated with chemotherapy (CT) alone or CT combined with radiation therapy (RT) (CT+RT). There is no robust evidence supporting one over the other. The present study compares the two treatment modalities in terms of their survival outcomes and safety profile. The retrospective study includes 29 nonmetastatic, unresectable, LAPC patients who were treated with CT+RT (21 patients) or CT alone (8 patients) during November 2019 to September 2023. CT consisted of FOLFIRINOX or Gemcitabine-based regimens. CT+RT patients were treated with conventional (50.4 Gy/28fr) as well as hypofractionated RT dose schedules (39 Gy/13fr, 25 Gy/5fr, and 42 Gy/6fr). The primary endpoint of the study was the median overall survival (OS), and the secondary endpoints were the median progression-free survival (PFS) and acute and late radiation-induced toxicities. At a median follow-up of 24 months, patients of CT+RT group had prolonged survival compared to patients of CT alone group with median OS of 20 months versus 7 months (P = 0.0032) and median PFS of 15 months versus 5 months (P = 0.029). The majority of toxicities in CT+RT group were Grade 1-2 around 79%. However, Grade 3 or more late event was seen only in 1 (5%) patient. Incorporating radiation therapy along with CT should be the standard approach for unresectable LAPC patients improving survival with acceptable toxicities.
Alam et al. (Tue,) studied this question.