3D Radiotherapy Can Be Safely Combined With Sandwich Systemic Gemcitabine Chemotherapy in the Management of Pancreatic Cancer: Factors Influencing Outcome
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA (Australia)
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland (Australia)
- Department of Radiation Oncology, Murray Valley Private Hospital, Wodonga, Victoria (Australia)
- Adelaide Radiotherapy Centre, Adelaide, SA (Australia)
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria (Australia)
- Department of Radiation Oncology, The Alfred, Prahran, Victoria (Australia)
- Department of Radiation Oncology, St. George Hospital, Kogarah, NSW (Australia)
- Department of Radiation Oncology, Royal Perth Hospital, Perth, WA (Australia)
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW (Australia)
- Department of Radiation Oncology, Prince of Wales Hospital, Randwick, NSW (Australia)
- Eli Lilly Australia, West Ryde, NSW (Australia)
- School of Surgery and Pathology, University of Western Australia, Nedlands, WA (Australia)
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW (Australia)
Purpose: The aim of this Phase II study was to examine whether concurrent continuous infusion 5-fluorouracil (CI 5FU) plus three-dimensional conformal planning radiotherapy sandwiched between gemcitabine chemotherapy is effective, tolerable, and safe in the management of pancreatic cancer. Methods and Materials: Patients were enrolled in two strata: (1) resected pancreatic cancer at high risk of local relapse (postsurgery arm, n = 22) or (2) inoperable pancreatic cancer in head or body without metastases (locally advanced arm, n = 41). Gemcitabine was given at 1,000 mg/m{sup 2} weekly for 3 weeks followed by 1 week rest then 5-6 weeks of radiotherapy and concurrent CI 5FU (200 mg/m{sup 2}/day). After 4 weeks' rest, gemcitabine treatment was reinitiated for 12 weeks. Results: For the two arms combined, treatment-related Grade 3 and 4 toxicities were reported by 25 (39.7%) and 7 (11.1%) patients, respectively. No significant late renal or hepatic toxicity was observed. In the postsurgery arm (R1 54.5%), median time to progressive disease from surgery was 11.0 months, median time to failure of local control was 32.9 months, and median survival time was 15.6 months. The 1- and 2-year survival rates were 63.6% and 31.8%. No significant associations between outcome and mutations in K-ras or TP53 or microsatellite instability were identified. Post hoc investigation of cancer antigen 19-9 levels found baseline levels and increases postbaseline were associated with shorter survival (p = 0.0061 and p < 0.0001, respectively). Conclusions: This three-dimensional chemoradiotherapy regimen is safe and promising, with encouraging local control for a substantial proportion of patients, and merits testing in a randomized trial.
- OSTI ID:
- 21124150
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 70, Issue 5; Other Information: DOI: 10.1016/j.ijrobp.2007.08.070; PII: S0360-3016(07)04234-4; Copyright (c) 2008 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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