Combined Modality Therapy Increasing Local Control of Pancreatic Cancer

Abstract

Twenty patients with inoperable locally advanced Stage II and III pancreatic cancer were treated with combined modality therapy. Radiotherapy consisted of split courses of 2000 cGy each and, as needed, an additional 1400 cGy, separated by 2-week intervals. Simultaneous multidrug regimen chemotherapy consisted of 5-fluorouracil, continuous infusion, 1 g/m2 days 1-5; streptozotocin, 300-500 mg/m2 days 1, 2, 3; and cisplatin, 100 mg/m2 day 3 of every 4-week radiotherapy course (RT-FSP). Primary tumors decreased more than 50% in volume in 11 of 20 patients. Computed tomography scans demonstrated apparent complete disappearance of the primary tumor in 7 patients. Only 3 patients had tumor regrowth within the radiotherapy field, all after the end of radiotherapy. Local control improved as measured by increased frequency of tumor shrinkage and decreased frequency of primary tumor growth, recognizing the limitations of a pilot study and comparisons to best historical results achieved with standard short 5-fluorouracil schedules and radiotherapy. Successful local control largely eliminates the most common cause of refractory pain and may decrease the need for some forms of early palliative surgical intervention. Tumor shrinkage sometimes downstages tumors, creating frequent investigational opportunities for either elective extirpative surgery or intraoperative radiotherapy. This pilot experience also supports testing of expanded eligibility staging criteria for combined modality treatment and testing of new drugs as part of 5-fluorouracil-radiotherapy-based regimens.

Regional Treatment of Advanced Nonresectable and of Resected Pancreatic Cancer via Celiac Axis Infusion

“…Systemic chemotherapy in advanced pancreatic carcinoma has not been significantly better than supportive therapy alone. Median survival for com bination regimens range from 3 to only 6.5 months and are probably not longer than those obtained with 5-FU alone [4], Radiotherapy in combination with systemic chemotherapy (5-FU and others) was associated with a median survival of 10-12 months in localized advanced nonresectable cases [5][6][7], Even after resection, the me dian survival times rarely exceed 12 months. Again, only postoperative intensive radiochemotherapy has produced significant evidence of prolonged survival, as demon strated in a single randomized study [8], Since the results of that study still need confirmation by other groups, up to now, no postoperative treatment can be regarded as firm ly established.…”

Resection and radiochemotherapy of pancreatic cancer – the future?

“…The authors had applied 54 Gy radiotherapy together with 5-FU continuous infusion, streptozotocin and cisplatinum (RT-FSP), followed by systemic CT with 5-FU and folinic acid. The local tumour control was excellent with an overall primary tumour response rate of 63% [11]. Thirty percent (30%) of the whole patient group were resectable after downstaging, and the resectability was 67% in the 30 patients surgically explored for a resection.…”

Regional Celiac Artery Infusion as Adjuvant Treatment after Pancreatic Cancer Resection

“…Foo et al [5] reported that 54 Gy ± chemotherapy was more effective at reducing local recurrences than irradiation with 45 Gy but this was an uncontrolled study [5]. The occurrence of liver metas tasis is not influenced by radiotherapy ( ± chemotherapy) in the adjuvant, neoadjuvant or palliative settings [4,5,[19][20][21][22][23] nor by systemic adjuvant chemotherapy [ 18].…”