Treatment of Unresectable, Locally Advanced Pancreatic Adenocarcinoma with Combined Radiochemotherapy with 5-Fluorouracil and Cisplatin

Azria, D.; Ychou, Marc; Jacot, William; Thézenas, Simon; Lemanski, C.; Sénesse, Pierre; Prost, Patricia; Delard, R.; Masson, B.; Dubois, Jean‐Bernard

doi:10.1097/00006676-200211000-00007

Cited by 27 publications

(13 citation statements)

References 19 publications

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“…This is comparable to results published in international literature in which survival ranges from 9 to 14 months [3,7,8,9,10,11,12, 14,19,20,21,22,23,30,31,32,33,34,35,36,37]. …”

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

Locally Advanced Pancreatic Cancer Treated with Radiation and 5-Fluorouracil: A First Step to Neoadjuvant Treatment?

Smeenk

Castro²,

Jeekel³

et al. 2005

Dig Surg

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Aim of the Study: In two institutions, a retrospective analysis was performed on patients with histologically proven locally advanced pancreatic cancer without distant metastases. The aim of this analysis is to assess whether chemoradiotherapy provides survival benefit for patients with locally advanced pancreatic cancer. Methods: Forty-five patients from the Erasmus Medical Centre (Erasmus MC), Rotterdam, received 5-fluorouracil (5-FU) and radiotherapy and, 38 patients from the Academic Medical Centre Amsterdam (AMC) were offered the best supportive care. Radiotherapy consisted of 50 Gy external upper abdomen radiation in two courses, concomitant with intravenous 5-FU 25 mg/kg/ 24 h continuously on the first 4 days of each treatment course. Results: The treatment protocol was completed in 38 of 45 patients (84%) without complications. Radiological response was evaluated in 38 patients. Ten patients (26%) showed a partial response, stable disease was seen in 6 (16%) patients and progressive disease in 22 (58%) patients. A second-look operation was performed in 8 of 10 patients (72%) showing a radiological response, in 3 patients the tumour could be resected. Median overall survival time for the Erasmus MC group (n = 45) was 9.8 months compared to 7.6 months when the best supportive care was given (AMC group, p = 0.04). Conclusion: Although overall survival remains poor, treatment with 5-FU and radiotherapy might benefit some patients with locally advanced pancreatic cancer.

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“…This is comparable to results published in international literature in which survival ranges from 9 to 14 months [3,7,8,9,10,11,12, 14,19,20,21,22,23,30,31,32,33,34,35,36,37]. …”

Section: Discussionsupporting

confidence: 89%

“…In this study 26% of patients showed a response and 16% had stable disease after 2 months which is again comparable to international results [3,7,8,9, 11, 12, 19, 21,30,31,32,33,34,35]. However, only 2 patients (5%) of the total group underwent a radical (R0) resection.…”

Section: Discussionsupporting

confidence: 88%

Locally Advanced Pancreatic Cancer Treated with Radiation and 5-Fluorouracil: A First Step to Neoadjuvant Treatment?

Smeenk

Castro²,

Jeekel³

et al. 2005

Dig Surg

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“…We have also learned that weekly doses of gemcitabine of up to 250-300 mg/m 2 can be given without intolerable toxicity in parallel to radiotherapy [48][49][50][51][52][53][54][55][56][57][58][59]. Paclitaxel, oxaliplatin and cisplatin are potent radiosensitizers, which are tested in combination with radiotherapy for pancreatic cancer [53,[60][61][62][63][64]. Inoperable tumors of the pancreas are ideal targets for novel irradiation techniques like intensity-modulated radiotherapy used in conjunction with image guidance, e.g.…”

Section: Future Studiesmentioning

confidence: 99%

Should patients with locally advanced, non-metastatic carcinoma of the pancreas be irradiated?

et al. 2003

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“…Patient survival of this devastating disease is bleak with less than 5% of patients surviving 5 years after the time of diagnosis (Greenlee et al, 2000). The current treatment includes a combination of surgery, chemotherapy, and radiation without any major improvement in survival (Azria et al, 2002). Over 10 years ago, it was hypothesised that TNFa could increase tumour response to radiation through stimulation of the host antitumour immune responses, direct tumour-cell kill, or through the increase in tumour-cell sensitivity to radiation (Sersa et al, 1988;Hallahan et al, 1990;Gridley et al, 1994a, b;Kimura et al, 1999;Azria et al, 2003a).…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, at the time of diagnosis, the majority of patients (80 -90%) have locally or metastatic inoperable tumours. Radiation therapy (RT) alone or in combination with chemotherapy showed modest efficacy in local control and palliation (Andre et al, 2000;Kornek et al, 2000;Azria et al, 2002). Despite these intensive efforts to improve the efficacy of conventional therapy, no satisfactory progress in dealing with this cancer has been made.…”

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confidence: 99%

Potentiation of ionising radiation by targeting tumour necrosis factor alpha using a bispecific antibody in human pancreatic cancer

et al. 2003

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The aim of this study was to treat carcinoembryonic antigen (CEA)-expressing pancreatic carcinoma cells with tumour necrosis factor alpha (TNFa) and simultaneous radiation therapy (RT), using a bispecific antibody (BAb) anti-TNFa/anti-CEA. TNFa used alone produced a dose-dependent inhibition of the clonogenic capacity of the cultured cells. Flow cytometry analysis of cell cycle progression confirmed the accumulation of cells in G 1 phase after exposure to TNFa. When TNFa was added 12 h before RT, the surviving fraction at 2 Gy was 60% lower than that obtained with irradiation alone (0.29 vs 0.73, respectively, Po0.00001). In combination treatment, cell cycle analysis demonstrated that TNFa reduced the number of cells in radiation-induced G 2 arrest, blocked irreversibly the cells in G 1 phase, and showed an additive decrease of the number of cells in S phase. In mice, RT as a single agent slowed tumour progression as compared with the control group (Po0.00001). BAb þ TNFa þ RT combination enhanced the delay for the tumour to reach 1500 mm 3 as compared with RT alone or with RT þ TNFa (P ¼ 0.0011). Median delays were 90, 93, and 142 days for RT alone, RT þ TNFa, and RT þ BAb þ TNFa groups, respectively. These results suggest that TNFa in combination with BAb and RT may be beneficial for the treatment of pancreatic cancer in locally advanced or adjuvant settings.

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Treatment of Unresectable, Locally Advanced Pancreatic Adenocarcinoma with Combined Radiochemotherapy with 5-Fluorouracil and Cisplatin

Abstract: This RCT regimen had a good impact on clinical benefit in locally advanced pancreatic carcinoma, without severe side effects.

Cited by 27 publications

References 19 publications

Locally Advanced Pancreatic Cancer Treated with Radiation and 5-Fluorouracil: A First Step to Neoadjuvant Treatment?

Locally Advanced Pancreatic Cancer Treated with Radiation and 5-Fluorouracil: A First Step to Neoadjuvant Treatment?

Should patients with locally advanced, non-metastatic carcinoma of the pancreas be irradiated?

Potentiation of ionising radiation by targeting tumour necrosis factor alpha using a bispecific antibody in human pancreatic cancer

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