Treatment factors influencing survival in pancreatic carcinoma

Purpose: To identify the impact of treatment factors on overall survival in patients with pancreatic carcinoma. Patients and Methods: We performed a follow-up study on 38 patients with ad enocarcinoma of the pancreas treated from 1984 to 1998, 18/38 patients were resected. Irradiated volume included the primary tumor (or tumor bed) and regional lymph nodes. Thirty-seven patients received in addition chemothera py consisting of mitoxantrone, 5-fluorouracil and cis-platin, either i.v. ( 14/38) or i. a. (23/38). The influence of treatment related factors on the overall survival was tested. Biologically effective dose was calculated by the linear-quadratic model (alpha/beta = 25 Gy) and by losing 0.85 Gy per d ay starting accelerated repopulation at day 28. Results: Treatment factors influencing overall survival were resection (p = 0.02), overall treatment time (p = 0.03) and biologically effective dose ( p < 0.002). Total dose and kind of chemotherapy had no significant influenc e. Treatment volume had a negative correlation (r = -0.5, p = 0.06) with ov erall survival? without any correlation between tumor size, tumor stage, an d treatment volume. In multivariate analysis only biologically effective do se remained significant (p = 0.02). Conclusions: Among with surgery, biologically effective dose strongly influ ences overall survival in patients treated for pancreatic carcinoma. Treatm ent volume should be kept as small as possible and all efforts should be ma de to avoid treatment splits in radiation therapy.