Treatment perspectives in locally advanced unresectable pancreatic cancer

Abstract

Locally advanced unresectable pancreatic cancer is sometimes encountered without manifest distant metastases. Twenty patients with histologically proven unresectable pancreatic cancer without distant metastases were treated with radiotherapy and 5-fluorouracil (5-FU). Radiotherapy consisted of 50 Gy external upper abdomen radiation in two courses, concomitant with intravenous 5-FU 375 mg/m2 given as a bolus injection 4-6h before radiation on the first 4 days of each treatment course. The treatment protocol was completed in 18 patients without complications. The median survival time was 10 months which compares favourably with a 3-5 months median survival time when treatment is withheld. Nine patients (45 per cent) were alive at 1 year, two patients at 2, 3 and 4 years. A second-look operation was performed in four patients 6, 11, 12 and 22 months after completion of radiotherapy. In two patients the tumour could be resected. It appears that treatment with radiotherapy and 5-FU may benefit patients with locally advanced unresectable pancreatic cancer.

Intraoperative and conformal external‐beam radiation therapy with protracted 5‐fluorouracil infusion in patients with locally advanced pancreatic carcinoma

“…2,[21][22][23] Consequently, various ra- diation schedules and/or chemotherapy regimens have been tested in clinical trials for their ability to improve survival, but none have been conclusively shown to produce better survival rates than the treatment used in the GITSG randomized clinical trial. [3][4][5][6][7][8] In several studies, intensive irradiation consisting of a combination of EBRT and IORT has been performed. 9 -15 In initial studies, the MST for this treatment was reported to be approximately 15 months and the findings suggested that IORT enhanced survival in patients with locally advanced pancreatic carcinoma.…”

“…In previous reports on treatments for locally advanced pancreatic carcinoma, EBRT doses ranged from 40 grays (Gy) to 55 Gy and various chemotherapy regimens were combined with radiotherapy in an effort to improve the efficacy of radiotherapy. [3][4][5][6][7][8] In other studies, high radiation doses were administered using combinations of intraoperative radiotherapy (IORT) and EBRT or high-dose conformal radiotherapy. 9 -16 IORT or conformal irradiation using a three-dimensional irradiation system allows for reduction of the radiation dose delivered to tissues surrounding the pancreas.…”

Combined modality treatment with accelerated radiotherapy and chemotherapy in patients with locally advanced inoperable carcinoma of the pancreas: results of a feasibility study

“…After palliative surgery, median survival time is only 3-7 months (Brennan et al, 1989;De Rooij et al, 1991). Median survival time for patients with locally irresectable pancreatic carcinoma reported in radiooncological literature, using varying therapy schedules for radiochemotherapy, ranges from 7.5 to 16.5 months (Tepper et al, 1987(Tepper et al, , 1991Wagener et al, 1989;Seydel et al, 1990;Shibamoto et al, 1990;Boz et al, 1991;Jeekel et al, 1991;Montemaggi et al, 1991;Ardalan et al, 1994;Whittington et al, 1995; Table 3). …”

Staging for locally advanced pancreatic cancer

“…[16][17][18] Based on previous results in our centre, chemoradiotherapy is a promising option in patients with unresectable, non-metastasised pancreatic cancer based on laparoscopy. [19] The aim of this study was to address the role of a dedicated radiologist and high quality CT scanning in staging of patients referred with suspected locally advanced pancreatic cancer.…”