J Korean Soc Ther Radiol Oncol.  2002 Dec;20(4):328-333.

Concurrent Chemoradiation for Unresectable Pancreatic Cancer

Affiliations
  • 1Department of Radiation Oncology, Brain Korea 21 Project for Medical Science, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea. therapy@yumc.yonsei.ac.kr
  • 2Department of Internal Medicine, Brain Korea 21 Project for Medical Science, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE: To analyze the treatment results of concurrent chemoradiation with oral 5-FU plus Gemcitabine or Paclitaxel for unresectable pancreatic cancer. MATERIALS & METHODS: The patients, who were diagnosed by imaging modalities or by explo-laparotomy, were treated with concurrent chemoradiation. Radiotherapy was delivered to primary tumor and regional lymph nodes, and the total dose was 45 Gy. Patients received Gemcitabine 1,000 mg/m2 or Paclitaxel 50 mg/m2 weekly and oral 5-FU daily. The total number of cycles of chemotherapy ranged from 1 to 39 (median, 11 cycles). The follow-up period ranged from 6 to 36 months. Survival was analyzed using the Kaplan-Meier method.
RESULTS
Fifty-four patients between Jan. 1999 to Nov. 2001 were included in this study. Forty-two patients who completed the planned treatment were included in this analysis. The patients' age ranged from 37 to 73 years (median, 60 years) and the male to female ratio was 30:12. Treatment was interrupted for 12 patients due to; disease progression for 6 (50%), poor performance status for 4 (33.3%), intercurrent disease for 1 (8.3%), and refusal for 1 (8.3%). Response evaluation was possible for 40 patients. One patient gained complete remission and 24 patients gained partial remission, hence the response rate was 59%. The survival rates were 46.7% and 17.0% at 1 year and 2 years, respectively with a median survival time of 12 months. Patients treated with Paclitaxel showed superior outcomes compared to those patients treated with Gemcitabine, in terms of both response rate and survival rate although this difference was not statistically significant. Grade III or IV hematologic toxicity was shown in 8 patients (19%), while grade III or IV non-hematologic toxicity was shown in 5 patients (12%).
CONCLUSION
Concurrent chemoradiation with oral 5-FU and Gemcitabine or Paclitaxel improves both the response rate and survival rate in patients with unresectable pancreatic cancer. A prospective study should be investigated in order to improve both the patient selection and the treatment outcome as well as to reduce the toxicity.

Keyword

Unresectable pancreatic cancer; Concurrent chemoradiation; Gemcitabine; Paclitaxel

MeSH Terms

Disease Progression
Disulfiram
Drug Therapy
Female
Fluorouracil
Follow-Up Studies
Humans
Lymph Nodes
Male
Paclitaxel
Pancreatic Neoplasms*
Patient Selection
Radiotherapy
Survival Rate
Treatment Outcome
Disulfiram
Fluorouracil
Paclitaxel
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