The impact of radiation therapy and chemotherapy in locally advanced unresectable nonmetastatic pancreatic cancer patients treated in a tertiary care center.

Background: 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.

Methods: 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.

Results: 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.

Conclusion: Incorporating radiation therapy along with CT should be the standard approach for unresectable LAPC patients improving survival with acceptable toxicities.