Chemoradiation in Pancreatic Adenocarcinoma: A Literature Review

Abstract

Adenocarcinoma of the exocrine pancreas has an annual incidence of 7,400 cases in the U.K. In comparison with other common cancers of solid organs, namely, breast, colorectal, and prostate cancer, pancreatic cancer has a high morbidity and mortality. Radical resection is possible in only 15%-20% of patients, and only 3%-4% of all patients presenting with this condition achieve long-term control and cure. Various strategies in the form of neoadjuvant and adjuvant treatment have been employed over the years to improve outcome, with limited success. Systemic chemotherapy remains the gold standard in the metastatic setting in good performance status patients, and adjuvant chemotherapy after resection of localized and locally advanced cancer has been found to improve outcome. The role of radiotherapy, however, remains controversial and is an area that merits further investigation in well-conducted multicenter trials at various stages of the disease in combination with systemic agents and exploiting recent advances in the delivery of radiotherapy. In this article, we review the published literature on the use of chemoradiation as a modality in various stages of pancreatic adenocarcinoma and highlight areas that future trials in this field should target for a way forward in this malignancy. The Oncologist 2010;15:259 -269

A novel biliary stent loaded with 125I seeds in patients with malignant biliary obstruction: Preliminary results versus a conventional biliary stent

“…Unfortunately, it is often detected at an unresectable stage and associated with a poor prognosis and limited life expectancy, and the long-term survival rates remain dismal [3][4][5]14,15]. As a treatment method for unresectable adenocarcinomas related to bile duct obstruction, external-beam radiotherapy is an optional therapy but the treatment volumes are always large and include at-risk uninvolved lymph nodes, vessels and the organs surrounding the bile ducts and uninvolved ducts have poor radiation tolerance [16,17]. Stenting in the biliary obstruction is considered to be the preferred palliative therapy for unresectable patients, with a lower short-term complication rate and shorter time to restoration of oral intake and hospital stay than surgery [6,18,19].…”

“…Unfortunately, a paclitaxel-eluting biliary stent was reported not to prolong the stent patency and patient survival when compared with a conventional covered stent in patients with distal malignant biliary obstruction [21]. Intraoperative radiation therapy and brachytherapy can deliver a higher effective therapeutic dose to the carcinomas and limit the dose to normal organs and tissues concurrently, when compared with external beam radiation [16]. Previous results of brachytherapy with isotope seeds of 192 Ir or 125 I, employed in cholangiocarcinoma through access after percutaneous biliary stent placement, demonstrated better relief of the biliary obstruction and survival time without severe complications related to external beam radiation except cholangitis [22][23][24][25].…”

Benzyl isothiocyanate sensitizes human pancreatic cancer cells to radiation by inducing apoptosis

“…However, only 10-20% of cancers are suitable for tumor resection, after which local recurrences are common (2). Furthermore, pancreatic cancer cells have unusual resistance to both chemotherapy and radiotherapy (3,4). These facts warrant development of novel therapeutic radiosensitizers for the treatment of pancreatic cancer.…”

Assessing Treatment Effect in Pancreatic Cancer

“…3 Many groups have studied the clinical effectiveness of various preoperative chemotherapies and radiation therapy regimens. 32 Chemotherapy agents that have been used include gemcitabine, 5-fluorouracil, mitomycin C, platinum compounds, and paclitaxel, and the list continues to grow. Absorbed radiation doses (absorbed per unit of body weight of tissue) to the pancreas typically range from 30 to 60 Gy.…”