Cancer Research and Treatment

Original Articles

Gastrointestinal cancer

Prevalence and Risk Factors of Germline Pathogenic Variants in Pancreatic Ductal Adenocarcinoma: Kum Hei Ryu, Sunhwa Park, Jung Won Chun, Eunhae Cho, Jongmun Choi, Dong-Eun Lee, Hyoeun Shim, Yun-Hee Kim, Sung-Sik Han, Sang-Jae Park, Sang Myung Woo, Sun-Young Kong; Cancer Res Treat. 2023;55(4):1303-1312. Published online April 3, 2023; DOI: https://doi.org/10.4143/crt.2023.291

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Purpose
The genetic attribution for pancreatic ductal adenocarcinoma (PDAC) has been reported as 5%-10%. However, the incidence of germline pathogenic variants (PVs) in Korean PDAC patients has not been thoroughly investigated. Therefore, we studied to identify the risk factors and prevalence of PV for future treatment strategies in PDAC.
Materials and Methods
Total of 300 (155 male) patients with a median age of 65 years (range, 33 to 90 years) were enrolled in National Cancer Center in Korea. Cancer predisposition genes, clinicopathologic characteristics, and family history of cancer were analyzed.
Results
PVs were detected in 20 patients (6.7%, median age 65) in ATM (n=7, 31.8%), BRCA1 (n=3, 13.6%), BRCA2 (n=3), and RAD51D (n=3). Each one patient showed TP53, PALB2, PMS2, RAD50, MSH3, and SPINK1 PV. Among them, two likely PVs were in ATM and RAD51D, respectively. Family history of various types of cancer including pancreatic cancer (n=4) were found in 12 patients. Three patients with ATM PVs and a patient with three germline PVs (BRCA2, MSH3, and RAD51D) had first-degree relatives with pancreatic cancer. Familial pancreatic cancer history and PVs detection had a significant association (4/20, 20% vs. 16/264, 5.7%; p=0.035).
Conclusion
Our study demonstrated that germline PVs in ATM, BRCA1, BRCA2, and RAD51D are most frequent in Korean PDAC patients and it is comparable to those of different ethnic groups. Although this study did not show guidelines for germline predisposition gene testing in patients with PDAC in Korea, it would be emphasized the need for germline testing for all PDAC patients.

Citations

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FOXM1 promotes malignant biological behavior and metabolic reprogramming by targeting SPINK1 in hepatocellular carcinoma and affecting the p53 pathway
Xu Ding, Jinjun Shi, Zhengqing Lei, Guoqing Wang, Chenchun Fu, Xiangyu Su, Guangyu Zhu
Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease.2025; 1871(3): 167673. CrossRef
MLH1 Inhibits Metastatic Potential of Pancreatic Ductal Adenocarcinoma via Downregulation of GPRC5C
Wen-Jing Liu, Jun Lu, Wei-Xun Zhou, Jian-Zhou Liu, Li Zhou
Laboratory Investigation.2024; 104(9): 102107. CrossRef
Clinical Significance of PALB2 Pathogenic Germline Variant
Min-Chae Kang, R.N., Jong Eun Park, Mi-Ae Jang, Dongju Won, Boyoung Park, Seeyoun Lee, Dong Ock Lee, Kum Hei Ryu, Yoon-Jung Chang, Sun-Young Kong
Laboratory Medicine Online.2024; 14(4): 311. CrossRef
Prevalence Estimation of the PALB2 Germline Variant in East Asians and Koreans through Population Database Analysis
Jong Eun Park, Min-Chae Kang, Taeheon Lee, Eun Hye Cho, Mi-Ae Jang, Dongju Won, Boyoung Park, Chang-Seok Ki, Sun-Young Kong
Cancers.2024; 16(19): 3318. CrossRef
Understanding the Genetic Landscape of Pancreatic Ductal Adenocarcinoma to Support Personalized Medicine: A Systematic Review
Antonino Pantaleo, Giovanna Forte, Candida Fasano, Martina Lepore Signorile, Paola Sanese, Katia De Marco, Elisabetta Di Nicola, Marialaura Latrofa, Valentina Grossi, Vittoria Disciglio, Cristiano Simone
Cancers.2023; 16(1): 56. CrossRef

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Prevalence of Psychological Symptoms in Patients Undergoing Pancreatoduodenectomy and Results of a Distress Management System: A Clinic-Based Study: Mee Joo Kang, Eun-Seung Yu, Young Hwa Kang, Hyeong Min Park, Sang-Jae Park, Sun-Whe Kim, Jong-Heun Kim, Sung-Sik Han; Cancer Res Treat. 2022;54(4):1138-1147. Published online January 4, 2022; DOI: https://doi.org/10.4143/crt.2021.842

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Purpose
Patients undergoing pancreatoduodenectomy are a high-risk group that requires psychosocial support. This study retrospectively reviewed the prevalence of psychological symptoms in patients undergoing pancreatoduodenectomy for periampullary neoplasm and the psychosocial referral rate after implementing full screening and triage algorithm for administering a distress management protocol based on the integrated supportive care system established in 2010.
Materials and Methods
From September 2010 to December 2018, insomnia, anxiety, and depression were screened on the first day of admission (T1) and on the 10th postoperative day (T2). Patients with clinical levels of distress were referred to a mental health clinic for appropriate aftercare.
Results
The adherence rate to routine screening was 82.7% (364/440). Among the 364 patients, the prevalence of insomnia, anxiety, and depression increased from 22.0% (T1) to 32.6% (T2, p=0.001), 29.1% to 33.6% (p=0.256), and 18.4% to 27.6% (p=0.001), respectively. Less than 45% of those with psychological symptoms expressed their needs for psychological supportive care. Among those with psychological symptoms at T2, clinical insomnia, anxiety, and depression were detected via in-depth evaluations among 77.2%, 38.1%, and 82.5% of patients, respectively. Patients who had two or more symptoms at T2 had a longer postoperative hospital stay, as compared to those with one or no symptoms (a median of 20.5 days vs. 18.0 days, p=0.006). Psychiatric consultation rate was 72.8% among patients with clinical psychological symptoms, and 74% of the consulted patients completed psychiatric intervention before discharge.
Conclusion
Over one-third of the patients had psychological symptoms before and after pancreatoduodenectomy. Implementing a routine psychological symptoms screening with a systematic psychiatric referral protocol enhanced surgeons’ responsiveness to patients’ psychological symptoms.

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Assessing the long-term priorities of pancreaticoduodenectomy survivors
Edward A. Joseph, Kara D. Bowers, Rebecca Marcus, Bibek Aryal, Suzanne C. Schiffman, Patrick L. Wagner, Sricharan Chalikonda, David L. Bartlett, Casey J. Allen
HPB.2024; 26(5): 703. CrossRef
Effect of postoperative application of esketamine on postoperative depression and postoperative analgesia in patients undergoing pancreatoduodenectomy: a randomized controlled trial protocol
Kaili Yu, Zhenguo Song, Bowen Zhang, Qian Pan, Shan Gan, Shaoyong Yang, Quanyong Yang, Xinhua Zuo, Yiqing Yin
Trials.2023;[Epub] CrossRef

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First Course of treatment and Prognosis of Exocrine Pancreatic Cancer in Korea from 2006 to 2017: Mee Joo Kang, Jiwon Lim, Sung-Sik Han, Hyeong Min Park, Sang-Jae Park, Young-Joo Won, Sun-Whe Kim; Cancer Res Treat. 2022;54(1):208-217. Published online May 21, 2021; DOI: https://doi.org/10.4143/crt.2021.421

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Purpose
Hospital-based clinical studies have limitations in holistic assessment of cancer treatment and prognosis, as they omit out-of-hospital patients including elderly individuals. This study aimed to investigate trends in initial treatment and corresponding prognosis of patients with exocrine pancreatic cancer (EPC) in Korea.
Materials and Methods
The Korea Central Cancer Registry data of patients with EPC from 2006 to 2017 were retrospectively reviewed. We defined the first course of treatment (FT) as the cancer-directed treatment administered within four months after cancer diagnosis according to Surveillance, Epidemiology, and End Results (SEER) program.
Results
Among 62,209 patients with EPC, localized and regional (LR) SEER stage; patients over 70 years old; and ductal adenocarcinoma excluding cystic or mucinous (DAC) accounted for 40.6%, 50.1%, and 95.9%, respectively. “No active treatment” (NT, 46.5%) was the most frequent, followed by non-surgical FT (28.7%) and surgical FT (22.0%). Among 25,198 patients with LR EPC, surgical FT increased (35.9% to 46.3%) and NT decreased (45.0% to 29.5%) from 2006 to 2017. The rate of surgical FT was inversely related to age (55.1% [< 70 years], 37.3% [70-79 years], 10.9% [≥ 80 years]). Five-year relative survival rates of LR DAC were higher after surgical FT than after NT in localized (46.1% vs. 12.9%) and regional stage (23.6% vs. 4.9%) from 2012 to 2017.
Conclusion
Less than half of overall patients with LR EPC underwent surgical FT, and this proportion decreased significantly in elderly individuals. Clinicians should focus attention on elderly patients with EPC to provide appropriate medical advice.

Citations

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Conditional Relative Survival of Exocrine Pancreatic Cancer: A Population-Based Study
Mee Joo Kang, Johyun Ha, Hyeong Min Park, Sang-Jae Park, Kyu-Won Jung, Sung-Sik Han
Annals of Surgical Oncology.2024; 31(2): 1178. CrossRef
Potential role of Fibrosis‐4 score in hepatocellular carcinoma screening: The Kangbuk Samsung Health Study
Sujeong Shin, Won Sohn, Yoosoo Chang, Yoosun Cho, Min‐Jung Kwon, Sarah H. Wild, Christopher D. Byrne, Seungho Ryu
Hepatology Research.2024; 54(6): 551. CrossRef
Three-year follow-up study reveals improved survival rate in NSCLC patients underwent guideline-concordant diagnosis and treatment
Huijuan Mu, Xing Yang, Yanxia Li, Bingzheng Zhou, Li Liu, Minmin Zhang, Qihao Wang, Qian Chen, Lingjun Yan, Wei Sun, Guowei Pan
Frontiers in Oncology.2024;[Epub] CrossRef
Epidemiological trends and factors associated with survival in patients with medulloblastoma: A 45-year population-based retrospective study
Dongjie He, Yahui Yang, Peiwen Wu, Siying Zhu, Hao Chang, Chao Zhang, Qiuju Shao, Zongyan Yu
Journal of Clinical Neuroscience.2024; 126: 154. CrossRef
Surgical management for elderly patients with pancreatic cancer
Sun-Whe Kim
Annals of Surgical Treatment and Research.2023; 105(2): 63. CrossRef
Exocrine pancreatic cancer as a second primary malignancy: A population-based study
Mee Joo Kang, Jiwon Lim, Sung-Sik Han, Hyeong Min Park, Sung Chun Cho, Sang-Jae Park, Sun-Whe Kim, Young-Joo Won
Annals of Hepato-Biliary-Pancreatic Surgery.2023; 27(4): 415. CrossRef
Distinct prognosis of biliary tract cancer according to tumor location, stage, and treatment: a population-based study
Mee Joo Kang, Jiwon Lim, Sung-Sik Han, Hyeong Min Park, Sun-Whe Kim, Woo Jin Lee, Sang Myung Woo, Tae Hyun Kim, Young-Joo Won, Sang-Jae Park
Scientific Reports.2022;[Epub] CrossRef
Trend Analysis and Prediction of Hepatobiliary Pancreatic Cancer Incidence and Mortality in Korea
Hyeong Min Park, Young-Joo Won, Mee Joo Kang, Sang-Jae Park, Sun-Whe Kim, Kyu-Won Jung, Sung-Sik Han
Journal of Korean Medical Science.2022;[Epub] CrossRef
Epidemiology of Gastric Cancer in Korea: Trends in Incidence and Survival Based on Korea Central Cancer Registry Data (1999–2019)
Sin Hye Park, Mee Joo Kang, E Hwa Yun, Kyu-Won Jung
Journal of Gastric Cancer.2022; 22(3): 160. CrossRef
Incidence, mortality and survival of gallbladder, extrahepatic bile duct, and pancreatic cancer using Korea central cancer registry database: 1999-2019
Mee Joo Kang, E Hwa Yun, Kyu-Won Jung, Sang-Jae Park
Annals of Hepato-Biliary-Pancreatic Surgery.2022; 26(3): 220. CrossRef
Incidence, mortality, and survival of liver cancer using Korea central cancer registry database: 1999-2019
Sung Yeon Hong, Mee Joo Kang, Taegyu Kim, Kyu-Won Jung, Bong-Wan Kim
Annals of Hepato-Biliary-Pancreatic Surgery.2022; 26(3): 211. CrossRef

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Validation of the 8th AJCC Cancer Staging System for Pancreas Neuroendocrine Tumors Using Korean Nationwide Surgery Database: Yunghun You, Jin-Young Jang, Song Cheol Kim, Yoo-Seok Yoon, Joon Seong Park, Chol Kyoon Cho, Sang-Jae Park, Jae Do Yang, Woo Jung Lee, Tae Ho Hong, Keun Soo Ahn, Chi-Young Jeong, Hyeon Kook Lee, Seung Eun Lee, Young Hoon Roh, Hee Joon Kim, Hongbeom Kim, In Woong Han; Cancer Res Treat. 2019;51(4):1639-1652. Published online April 19, 2019; DOI: https://doi.org/10.4143/crt.2019.023

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Purpose
The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic neuroendocrine tumor (PNET) included several significant changes. We aim to evaluate this staging system compared to the 7th edition AJCC staging system and European Neuroendocrine Tumors Society (ENETS) system.
Materials and Methods
We used Korean nationwide surgery database (2000-2014). Of 972 patients who had undergone surgery for PNET, excluding patients diagnosed with ENETS/World Health Organization 2010 grade 3 (G3), only 472 patients with accurate stage were included.
Results
Poor discrimination in overall survival rate (OSR) was noted between AJCC 8th stage III and IV (p=0.180). The disease-free survival (DFS) curves of 8th AJCC classification were well separated between all stages. Compared with stage I, the hazard ratio of II, III, and IV was 3.808, 13.928, and 30.618, respectively (p=0.007, p < 0.001, and p < 0.001). The curves of OSR and DFS of certain prognostic group in AJCC 7th and ENETS overlapped. In ENETS staging system, no significant difference in DFS between stage IIB versus IIIA (p=0.909) and IIIA versus IIIB (p=0.291). In multivariable analysis, lymphovascular invasion (p=0.002), perineural invasion (p=0.003), and grade (p < 0.001) were identified as independent prognostic factors for DFS.
Conclusion
This is the first large-scale validation of the AJCC 8th edition staging system for PNET. The revised 8th system provides better discrimination compared to that of the 7th edition and ENETS TNM system. This supports the clinical use of the system.

Citations

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Imaging Update of Pancreatic Neuroendocrine Neoplasms
Eric Rupe, Mahmoud Diab, LeeAnn Xoubi, Noha Kabeel, Ajaykumar Morani, Albert Klekers, Priya Bhosale
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Prognostic value of CT-based radiomics in grade 1–2 pancreatic neuroendocrine tumors
Subin Heo, Hyo Jung Park, Hyoung Jung Kim, Jung Hoon Kim, Seo Young Park, Kyung Won Kim, So Yeon Kim, Sang Hyun Choi, Jae Ho Byun, Song Cheol Kim, Hee Sang Hwang, Seung Mo Hong
Cancer Imaging.2024;[Epub] CrossRef
Contemporary Approaches to the Surgical Management of Pancreatic Neuroendocrine Tumors
Akash Kartik, Valerie L. Armstrong, Chee-Chee Stucky, Nabil Wasif, Zhi Ven Fong
Cancers.2024; 16(8): 1501. CrossRef
Optimal surgical management of unifocal vs. multifocal NF-PNETs: a respective cohort study
Juwan Kim, Seung Soo Hong, Sung Hyun Kim, Ho Kyong Hwang, Chang Moo Kang
World Journal of Surgical Oncology.2024;[Epub] CrossRef
NON-FUNCTIONING SPORADIC PANCREATIC NEUROENDOCRINE TUMOR IS AN INDEPENDENT RISK FACTOR FOR RECURRENCE AFTER SURGICAL TREATMENT
Estela Regina Ramos Figueira, André Luis Montagnini, Jessica Okubo, Ana Gabriela Vivarelli Fernandes, Marina Alessandra Pereira, Ulysses Ribeiro Junior, Paulo Herman, José Jukemura
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo).2024;[Epub] CrossRef
Venous invasion and lymphatic invasion are correlated with the postoperative prognosis of pancreatic neuroendocrine neoplasm
Sho Kiritani, Junichi Arita, Yuichiro Mihara, Rihito Nagata, Akihiko Ichida, Yoshikuni Kawaguchi, Takeaki Ishizawa, Nobuhisa Akamatsu, Junichi Kaneko, Kiyoshi Hasegawa
Surgery.2023; 173(2): 365. CrossRef
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Aleksander Kosmala, Sebastian E. Serfling, Wiebke Schlötelburg, Thomas Lindner, Kerstin Michalski, Andreas Schirbel, Takahiro Higuchi, Philipp E. Hartrampf, Andreas K. Buck, Alexander Weich, Rudolf A. Werner
Clinical Nuclear Medicine.2023; 48(1): 35. CrossRef
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Sean Lim, Lynn Chong, Saania Peeroo, Olukunle Onasanya, Evelyn He, Simon Banting, Daniel Croagh
ANZ Journal of Surgery.2023; 93(1-2): 160. CrossRef
Validation of a supplementary condition of eighth AJCC staging system for stage II hepatocellular carcinoma
Min Li, Linquan Wu, Shuaiwu Luo, Yaran Liu, Chi Sun, Enliang Li, Jiakun Wang, Bowen Li, Zhihao Huang, Jin Ge, Jun Lei, Fan Zhou, Wenjun Liao
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Xiao-Ya Shi, Yan Wang, Xuan Zhou, Meng-Li Xie, Qian Ma, Gan-Xin Wang, Jing Zhan, Yi-Ming Shao, Bai Wei
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Impact of CXCR4-Directed PET/CT on Staging and Proposed Oncologic Management in Patients With Digestive System Tumors
Alexander Weich, Sebastian E. Serfling, Wiebke Schlötelburg, Takahiro Higuchi, Philipp E. Hartrampf, Andreas Schirbel, Marieke Heinrich, Andreas K. Buck, Steven P. Rowe, Aleksander Kosmala, Rudolf A. Werner
Clinical Nuclear Medicine.2023; 48(7): 586. CrossRef
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Ce Sun, Huan Xu, Suixiang Wang, Ke Li, Pengzhe Qin, Boheng Liang, Lin Xu
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Yong-Jin Park, Young Suk Park, Seung Tae Kim, Seung Hyup Hyun
Molecular Imaging and Biology.2023; 25(5): 897. CrossRef
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Hebin Wang, Ding Ding, Tingting Qin, Hang Zhang, Jun Liu, Junfang Zhao, Chien-Hui Wu, Ammar Javed, Christopher Wolfgang, Shiwei Guo, Qingmin Chen, Weihong Zhao, Wei Shi, Feng Zhu, Xingjun Guo, Xu Li, Feng Peng, Ruizhi He, Simiao Xu, Jikuan Jin, Yi Wu, Abu
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In Woong Han, Jangho Park, Eun Young Park, So Jeong Yoon, Gang Jin, Dae Wook Hwang, Kuirong Jiang, Wooil Kwon, Xuefeng Xu, Jin Seok Heo, De-Liang Fu, Woo Jung Lee, Xueli Bai, Yoo-Seok Yoon, Yin-Mo Yang, Keun Soo Ahn, Chunhui Yuan, Hyeon Kook Lee, Bei Sun,
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Development and Validation of a Modified Eighth AJCC Staging System for Primary Pancreatic Neuroendocrine Tumors
Xu-Feng Zhang, Feng Xue, Zheng Wu, Alexandra G. Lopez-Aguiar, George Poultsides, Eleftherios Makris, Flavio Rocha, Zaheer Kanji, Sharon Weber, Alexander Fisher, Ryan Fields, Bradley A. Krasnick, Kamran Idrees, Paula M. Smith, Cliff Cho, Megan Beems, Yi Ly
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Development and Validation of Prognostic Nomograms for Periampullary Neuroendocrine Neoplasms: A SEER Database Analysis
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Proximal Resection Margins: More Prognostic than Distal Resection Margins in Patients Undergoing Hilar Cholangiocarcinoma Resection: Tae Yoo, Sang-Jae Park, Sung-Sik Han, Seong Hoon Kim, Seung Duk Lee, Tae Hyun Kim, Soon-ae Lee, Sang Myung Woo, Woo Jin Lee, Eun Kyung Hong; Cancer Res Treat. 2018;50(4):1106-1113. Published online November 16, 2017; DOI: https://doi.org/10.4143/crt.2017.320

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Purpose
Even though the therapeutic gold standard of hilar cholangiocarcinoma (HCCA) resection is cancer-free resection margin (RM), surgical treatment still remains challenging. This study evaluated the prognostic significance of RM status in resected HCCA patients and identified survival prognostic factors.
Materials and Methods
We reviewed records of 96 HCCA patients who underwent surgery from 2001 to 2012 and analyzed the RM status and prognostic factors that affecting survival.
Results
Negative RM (n=31, 33%) was significantly associated with better survival vs. positive RM (n=65, 67%) (mean survival time [MST], 33 months vs. 21 months; p=0.011). Margins with histological findings of non-dysplastic epithelium, low-grade dysplasia, and carcinoma in situ were not associated with survival differences (MST, 33 months vs. 33 months vs. 30 months; p=0.452), whereas positive margins were associated with poorer survival relative to carcinoma in situ (MST, 30 months vs. 21 months; p=0.050). Among patients with R0 resection, narrow (≤ 5 mm) and wide (> 5 mm) margins were not associated with survival differences (MST, 33 months vs. 30 months; p=0.234). Although positive proximal RM was associated with poorer survival compared to negative RM (MST, 19 vs. 33; p=0.002), no survival difference was observed between positive and negative distal RMs (MST, 30 vs. 33; p=0.628). Proximal RM positivity (hazard ratio [HR], 2.688; p=0.007) and nodal involvement (HR, 3.293; p < 0.001) were independent survival prognostic factors.
Conclusion
A clear RM, especially proximal RM status, was significant prognosticator, and proximal bile duct resection to the greatest technically feasible extent may be necessary, with careful consideration of the potential morbidity and oncologic outcomes after resection. However, an aggressive approach to obtain a negative distal RM might be controversial and should be considered carefully, depending on the patient's status.

Citations

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Molecular profiling and prognostic analysis in Chinese cholangiocarcinoma: an observational, retrospective single-center study
Changkun Zhang, Xia You, Qin Zhang, Dong Wang
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Radiographic features predictive of recurrence and survival after surgical resection of perihilar cholangiocarcinoma
Julaluck Promsorn, Panjaporn Naknan, Aumkhae Sookprasert, Kosin Wirasorn, Jarin Chindaprasirt, Attapol Titapun, Piyapharom Intarawichian, Mukesh Harisinghani
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Rabea Margies, Lisa-Katharina Gröger, Beate K. Straub, Fabian Bartsch, Hauke Lang
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Induction Chemotherapy with Gemcitabine and Cisplatin Followed by Simultaneous Integrated Boost–Intensity Modulated Radiotherapy with Concurrent Gemcitabine for Locally Advanced Unresectable Pancreatic Cancer: Results from a Feasibility Study: Sang Myung Woo, Min Kyeong Kim, Jungnam Joo, Kyong-Ah Yoon, Boram Park, Sang-Jae Park, Sung-Sik Han, Ju Hee Lee, Eun Kyung Hong, Yun-Hee Kim, Hae Moon, Sun-Young Kong, Tae Hyun Kim, Woo Jin Lee; Cancer Res Treat. 2017;49(4):1022-1032. Published online January 19, 2017; DOI: https://doi.org/10.4143/crt.2016.495

Abstract PDF Supplementary Material PubReader ePub

Purpose
This study assessed the feasibility and compliance of induction chemotherapy with gemcitabine and cisplatin followed by simultaneous integrated boost–intensity modulated radiotherapy (SIB-IMRT) with concurrent gemcitabine in patients with locally advanced unresectable pancreatic cancer.
Materials and Methods
In this trial, patients received induction chemotherapy consisting of gemcitabine (1,000 mg/m²) and cisplatin (25 mg/m2) on days 1, 8, and 15 of each treatment cycle. Patients were subsequently treated with gemcitabine (300 mg/m²/wk) during SIB-IMRT. The patients received total doses of 55 and 44 Gy in 22 fractions to planning target volume 1 and 2, respectively. As an ancillary study, digital polymerase chain reaction was performed to screen for the seven most common mutations in codons 12 and 13 of the KRAS oncogene of circulating cell free DNA (cfDNA).
Results
Forty-four patients were enrolled between 2012 and 2015. Of these, 33 (75%) completed the treatment. The most common toxicities during induction chemotherapy were grades 3 and 4 neutropenia (18.2%), grade 3 nausea (6.8%) and vomiting (6.8%). The most common toxicities during SIB-IMRT were grade 3 neutropenia (24.2%) and grade 3 anemia (12.1%). Ten patients (23%) underwent a curative resection after therapy. Median overall survival was significantly longer in patients who underwent curative resection (16.8 months vs. 11 months, p < 0.01). The median cfDNA concentration was significantly lower after treatment (108.5 ng/mL vs. 18.4 ng/mL, p < 0.001).
Conclusion
Induction chemotherapy with gemcitabine and cisplatin followed by concurrent SIB-IMRT was well tolerated and active.

Citations

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