Radiation therapy in the treatment of irresectable adenocarcinoma of the pancreas

Haslam, John Battle; Cavanaugh, Patrick J.; Stroup, Steven L.

doi:10.1002/1097-0142(197312)32:6<1341::aid-cncr2820320609>3.0.co;2-a

Cited by 155 publications

(23 citation statements)

References 3 publications

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“…We did not find any randomised controlled trials that compared radiation alone or chemoradiation alone to BSC. The basis for incorporating radiation therapy in pancreatic cancer was based on a Mayo clinic randomised controlled trial that randomised patients to receive radiotherapy or 5FU-based radiotherapy (Moertel et al, 1969) and an uncontrolled study of 23 patients who received radiotherapy (5040 -6680 rad), with 13 patients also receiving 5FU (Haslam et al, 1973). Median survival in the study by Haslam et al (1973) was 7.5 months.…”

Section: Management Of Locally Advanced Pancreatic Cancer a Sultana Ementioning

confidence: 99%

Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy

et al. 2007

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There is no consensus on the management of locally advanced pancreatic cancer, with either chemotherapy or combined modality approaches being employed (Maheshwari and Moser, 2005). No published meta-analysis (Fung et al, 2003;Banu et al, 2005;Liang, 2005;Bria et al, 2006;Milella et al, 2006) has included randomised controlled trials employing radiation therapy. The aim of this systematic review was to compare the following: (i) chemoradiation followed by chemotherapy (combined modality therapy) vs best supportive care (ii) radiotherapy vs chemoradiation (iii) radiotherapy vs combined modality therapy (iv) chemotherapy vs combined modality therapy (v) 5FU-based combined modality treatment vs another-agent-based combined modality therapy. Relevant randomised controlled trials were identified by searching databases, trial registers and conference proceedings. The primary end point was overall survival and secondary end points were progression-free survival/time-to-progression, response rate and adverse events. Survival data were summarised using hazard ratio (HR) and response-rate/adverse-event data with relative risk. Eleven trials involving 794 patients met the inclusion criteria. Length of survival with chemoradiation was increased compared with radiotherapy alone (two trials, 168 patients, HR 0.69; 95% confidence interval (CI) 0.51 -0.94), but chemoradiation followed by chemotherapy did not lead to a survival advantage over chemotherapy alone (two trials, 134 patients, HR 0.79; CI 0.32 -1.95). Meta-analyses could not be performed for the other comparisons. A survival benefit was demonstrated for chemoradiation over radiotherapy alone. Chemoradiation followed by chemotherapy did not demonstrate any survival advantage over chemotherapy alone, but important clinical differences cannot be ruled out due to the wide CI.

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Section: Management Of Locally Advanced Pancreatic Cancer a Sultana Ementioning

confidence: 99%

Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy

et al. 2007

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“…Although accepted now as standard of care, for a long time the benefits of administering adjuvant chemotherapy with or without radiotherapy following resection were unclear. In trials conducted in the late 1960s and early 1970s, patients with advanced unresectable pancreatic cancer received external beam radiotherapy with or without systemic chemotherapy [19,20]. As a result of the antitumour activity observed in these studies, the first randomized trial of adjuvant therapy was initiated by the Gastrointestinal Tumour Study Group (GITSG) in which patients undergoing resection with curative intent received 5-FU + folinic acid administered with radiotherapy or underwent observation alone [21].…”

Section: Chemotherapy/chemoradiotherapymentioning

confidence: 99%

Recent Developments and Current Issues in the Treatment of Pancreatic Cancer

Oettle¹

2013

JCT

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Presently, many questions exist about what the optimal regimen comprises for all stages and treatment settings for pancreatic cancer. Since the CONKO-001 trial, adjuvant therapy following resection has become standard of care; however, outcomes are poor, with most patients experiencing disease recurrence, and new therapies have yet to be validated. Furthermore, the value of adjuvant radiotherapy has still not been clearly defined. Targeted treatment in combination with chemotherapy has been mostly disappointing so far in the adjuvant setting but immunotherapy holds potential for improving survival outcomes. Neoadjuvant treatment does not appear to provide much benefit in resectable patients but in the small subgroup of patients with borderline resectable/unresectable locally advanced disease it may increase the possibility of an R0 resection and, consequently, a substantial increase in survival duration. Use of capecitabine-based radiotherapy in patients with unresectable locally advanced disease appears to be more efficacious and better tolerated than gemcitabine-based chemoradiotherapy, with respect to survival outcomes. However, as with adjuvant treatment, the benefit of adding radiotherapy has not yet been definitively demonstrated. In patients with metastatic pancreatic cancer, targeting the stroma with nab-paclitaxel has shown promising results in a phase III trial setting when administered in combination with gemcitabine and, furthermore, this regimen is suitable for a broad range of patients due to its generally good tolerability profile. Because of its high toxicity, FOLFIRINOX is more suitable for younger patients with an excellent performance status who can withstand aggressive treatment and in patients with a worse performance status, gemcitabine monotherapy is considered to be a more appropriate treatment. Alternatively, gemcitabine in combination with erlotinib, the only targeted compound that has resulted in significant albeit small improvements in survival in patients with advanced disease, could be selected. However, the benefit-risk profile of this regimen is only favorable in a strictly defined, small patient subgroup who develop a treatment-related rash. Finally, with the elucidation of prognostic and predictive markers, treatment is expected to become ever more individualized, leading to improved efficacy outcomes and less unnecessary toxicity.

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“…, radiotherapy (2), chemoradiotherapy (3,4) and immunotherapy (5,6). with pancreatic cancer or for early estimation of the effects of chemotherapy (12) and radiotherapy (13).…”

Section: Pancreatic Cancer Is One Of the Most Difficult Diseases To Dmentioning

confidence: 99%

Modalities for Evaluating Chemotherapeutic Efficacy and Survival Time in Patients with Advanced Pancreatic Cancer: Comparison between FDG-PET, CT, and Serum Tumor Markers

et al. 2009

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Radiation therapy in the treatment of irresectable adenocarcinoma of the pancreas

Cited by 155 publications

References 3 publications

Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy

Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy

Recent Developments and Current Issues in the Treatment of Pancreatic Cancer

Modalities for Evaluating Chemotherapeutic Efficacy and Survival Time in Patients with Advanced Pancreatic Cancer: Comparison between FDG-PET, CT, and Serum Tumor Markers

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