Comparing Chemoradiation, 125I Seed Implantation Combined with Chemotherapy, and Chemotherapy Alone Efficacy in Treating Unresectable Locally Advanced Pancreatic Cancer

Abstract Background: The prognosis of unresectable locally advanced pancreatic cancer (LAPC) remains dismal, and the optimal modality is unclear. This study compared four common treatments for LAPC, including concurrent chemotherapy combined with high-dose radiation (DT>50Gy) (CCHRT), concurrent chemotherapy combined with low-dose radiation (DT50 Gy) (CCLRT), 125I seed implantation combined with chemotherapy, and chemotherapy alone (CA).Materials/Methods: 89 patients with unresectable locally advanced pancreatic cancer were enrolled in this retrospective study. Overall survival was assessed using the Kaplan-Meier method and Cox regression. All four groups were first compared simultaneously and then in every two.Results: In the parallel comparison of all four groups, CCHRT-receiving patients demonstrated better OS benefits than their CCLRT-, 125I seed implantation combined with chemotherapy-, or CA-receiving counterparts (P=0.030). Comparisons in pairs revealed that patients given CCHRT showed significantly better OS benefits than those receiving CCLRT (13 vs. 7 months, P=0.006). CCHRT-receiving patients also had significantly better OS than their 125I seed implantation combined with chemotherapy-receiving counterparts (13 vs. 10 months, P=0.003). However, there was no statistical difference in OS between CCHRT- and CA-receiving patients, CCLRT- and 125I seed implantation combined with chemotherapy-receiving patients, CCLRT- and CA-receiving patients, 125I seed implantation combined with chemotherapy- and CA-receiving patients.Conclusions: CCHRT-receiving patients with unresectable LAPC demonstrated better OS than those on CCLRT, 125I seed implantation combined with chemotherapy, or CA. Further randomized clinical trials are warranted.