Additionally, the optimal time to evaluate CA 19-9 has not been f

Additionally, the optimal time to evaluate CA 19-9 has not been fully investigated in patients receiving definitive CRT, chemotherapy alone, as well as postoperative setting. In our study, median time from the end

of concurrent CRT to post CRT CA 19-9 was 36 days (range, 0.00-168.81 days). In RTOG 9704, the median time from surgery to the blood draw for postoperative CA 19-9 determination was 45 days (range, 11 to 57 days) as a secondary end point of its phase III study (4). To correct for the variability in the time between CRT and evaluation of the first post CRT CA19-9 value, we chose to measure survival as a time-varying covariate Inhibitors,research,lifescience,medical from the time of post CRT CA19-9 measurement Inhibitors,research,lifescience,medical rather than from CRT. Further study is warranted to determine the best time for CA 19-9 measurement to predict survival. Patients who develop early metastasis are unlikely to benefit from radiation, and identifying

this population prior to radiation would be ideal. An attractive strategy to facilitate patient selection for CRT is through Inhibitors,research,lifescience,medical a trial of systemic therapy. The time interval between the onset of chemotherapy and CRT provides an observation period of selleck inhibitor approximately 2 to 3 months. Restaging at the end of this period may identify the emergence of overt metastatic disease. In a study by The Groupe Cooperateur Multidisciplinaire en Oncologie (GERCOR) LAP07, 181 patients were reviewed who were treated with 5-fluorouracil (5-FU) or gemcitabine based chemotherapy for four months. Those without evidence

of disease progression were given additional chemotherapy or chemoradiation. Overall survival was improved in patients who went on to receive chemoradiation (17). Inhibitors,research,lifescience,medical An accurate surrogate marker for disease progression such as CA 19-9 could further identifying those patients that would most benefit from intensification of therapy. Substantially rising CA 19-9 levels during the induction period may be a harbinger of occult metastatic disease which would allow more careful selection of patients Inhibitors,research,lifescience,medical who would most likely benefit from local therapy. The half-life of serum CA 19-9 levels are approximately 1 day but can vary from less than 1 day to 3 days. The median lead time for CA 19-9 elevation before detection of a clinical relapse was 23 weeks (range, 2-48 weeks) (10). Thus, there is a need to optimize the timing of serum measurement Thalidomide that must be validated in a prospective clinical trial. We demonstrated the prognostic impact of the post CRT CA 19-9 levels. Patients with a post CRT CA 19-9 level greater than 85.5 U/mL had significantly worse overall survival in multivariate analysis. These patients may not benefit from intensification of therapy and could be considered for alternative management scheme as those with lower levels of CA 19-9 would benefit from a more aggressive therapeutic approach. Conclusions We suggest that CA 19-9 levels be obtained pre and post chemoradiotherapy.

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