Objective: To evaluate the outcome of preoperative gemcitabine-based chemoradiation therapy (CRT) for borderline resectable pancreatic cancer (BRPC), focusing on the associations among the tumor-vascular relationship, surgical outcomes, and pattern of recurrence.Summary Background Data: Among the various multimodal treatment strategies for pancreatic cancer, preoperative CRT and subsequent surgery is 1 promising strategy for BRPC.Methods: A total of 184 patients with BRPC received preoperative CRT. BRPC was classified as follows, based on radiographic findings before the initiation of preoperative CRT: BR-V, a tumor involving the portal-superior mesenteric vein without arterial involvement; and BR-A, a tumor with the involvement of a relevant major artery. We assessed the association of these 2 subgroups with the following parameters: (1) resection rate, (2) survival, and (3) pattern of recurrence.Results: The resection rate of BR-V cases (84%) was significantly higher than that of BR-A cases (57%) (P< 0.001). The 5-year survival rates of the resected BR-Vand BR-A cases were 51% and 25%, respectively (P = 0.003). The 5-year cumulative incidence of distant recurrence was significantly higher in the BR-A cases compared with the BR-V cases (67% vs 54%, P = 0.006); however, the 5-year cumulative incidence of local recurrence was not significantly different between the groups.Conclusions: In BRPC, arterial involvement was associated with impaired outcome regarding resection rate and survival, possibly due to the difference in the underlying pathophysiology between BR-Vand the advanced nature of BR-A as a systemic disease.
Purpose: To delineate changing trends in radical external beam radiotherapy (EBRT) for prostate cancer in Japan.Methods and Materials: Data from 841 patients with clinically localized prostate cancer treated with EBRT in the Japanese Patterns of Care Study (PCS) from 1996 to 2005 were analyzed.Results: Significant increases in the proportions of patients with stage T1 to T2 disease and decrease in prostate-specific antigen values were observed. Also, there were significant increases in the percentages of patients treated with radiotherapy by their own choice. Median radiation doses were 65.0 Gy and 68.4 Gy from 1996 to 1998 and from 1999 to 2001, respectively, increasing to 70 Gy from 2003 to 2005. Moreover, conformal therapy was more frequently used from 2003 to 2005 (84.9%) than from 1996 to 1998 (49.1%) and from 1999 to 2001 (50.2%). On the other hand, the percentage of patients receiving hormone therapy from 2003 to 2005 (81.1%) was almost the same as that from 1996 to 1998 (86.3%) and from 1999 to 2001 (89.7%). Compared with the PCS in the United States, patient characteristics and patterns of treatments from 2003 to 2005 have become more similar to those in the United States than those from 1996 to 1998 and those from 1999 to 2001.Conclusions: This study indicates a trend toward increasing numbers of patients with early-stage disease and increasing proportions of patients treated with higher radiation doses with advanced equipment among Japanese prostate cancer patients treated with EBRT during 1996 to 2005 survey periods. Patterns of care for prostate cancer in Japan are becoming more similar to those in the United States. (C) 2011 Elsevier Inc.
