Combined modality treatment of localized unresectable adenocarcinoma of the pancreas

Mohiuddin, Mohammed; Cantor, Ronald; Biermann, William A.; Weiss, Stephen M.; Barbot, Donna J.; Rosato, Francis E.

doi:10.1016/0360-3016(88)90054-5

Cited by 65 publications

(14 citation statements)

References 18 publications

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“…caused partial tumor regression in over 50% of patients and temporary pain reduction (lasting for 2-4 months) in about 25% of patients [34]. No positive brachytherapy influence in terms of survival time was found [7, 12, 33–35]. …”

Section: Discussionmentioning

confidence: 99%

“…Being one of the complimentary methods for palliative treatment, brachytherapy provides some risks. Although well tolerated by patients, it prolongs the time of surgical procedure and can be the cause of some intra- and postoperative complications [7, 33]. An increase of morbidity rate and even death rate could have been noticed especially during the first phase of introducing new procedure.…”

Section: Discussionmentioning

confidence: 99%

“…At the moment of diagnosis, the neoplasm is limited only to pancreas in 10% of patients. In almost 40% of patients neoplasms are locally advanced, and in over 50% distant metastases are observed [3, 6, 7]. Untreated patients with cancers localized in the head of pancreas usually survive only 3 months.…”

Section: Purposementioning

confidence: 99%

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Clinical Investigations Perioperative high dose rate (HDR) brachytherapy in unresectable locally advanced pancreatic tumors

Waniczek

Piecuch²,

Rudzki

et al. 2011

jcb

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PurposeThe aim of the study was to present an original technique of catheter implantation for perioperative HDR-Ir192 brachytherapy in patients after palliative operations of unresectable locally advanced pancreatic tumors and to estimate the influence of perioperative HDR-Ir192 brachytherapy on pain relief in terminal pancreatic cancer patients.Material and methodsEight patients with pancreatic tumors located in the head of pancreas underwent palliative operations with the use of HDR-Ir192 brachytherapy. All patients qualified for surgery reported pain of high intensity and had received narcotic painkillers prior to operation. During the last phase of the surgery, the Nucletron® catheters were implanted in patients to prepare them for later perioperative brachytherapy. Since the 6th day after surgery HDR brachytherapy was performed. Before each brachytherapy fraction the location of implants were checked using fluoroscopy. A fractional dose was 5 Gy and a total dose was 20 Gy in the area of radiation. A comparative study of two groups of patients (with and without brachytherapy) with stage III pancreatic cancer according to the TNM scale was taken in consideration.Results and ConclusionsThe authors claim that the modification of catheter implantation using specially designed cannula, facilitates the process of inserting the catheter into the tumor, shortens the time needed for the procedure, and reduces the risk of complications. Mean survival time was 5.7 months. In the group of performed brachytherapy, the mean survival time was 6.7 months, while in the group of no brachytherapy performed – 4.4 months. In the group of brachytherapy, only one patient increased the dose of painkillers in the last month of his life. Remaining patients took constant doses of medicines. Perioperative HDR-Ir192 brachytherapy could be considered as a practical application of adjuvant therapy for pain relief in patients with an advanced pancreatic cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical Investigations Perioperative high dose rate (HDR) brachytherapy in unresectable locally advanced pancreatic tumors

Waniczek

Piecuch²,

Rudzki

et al. 2011

jcb

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“…In order to improve outcomes, multimodal therapy has been evaluated in both resectable and unresectable (locally advanced) tumors, including chemotherapy, radiotherapy, and surgery. These studies have demonstrated 5-fluorouracil in combination with radiation therapy is beneficial in unresectable disease (3)(4)(5)(6). The combination of radiation and 5-FU also appears to improve clinical outcome in the neoadjuvant and adjuvant settings (7,8).…”

Section: Introductionmentioning

confidence: 97%

A Phase I Study of Eniluracil/5-FU in Combination with Radiation Therapy for Potentially Resectable and/or Unresectable Cancer of the Pancreas and Distal Biliary Tract

Czito

Hong

Cohen

et al. 2006

Cancer Investigation

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“…A survival advantage has been demonstrated for patients with locally advanced disease treated with 5-FUbased chemoradiation compared to no treatment or radiation therapy alone [7][8][9] . In this regard, 5-FU is still one of the tentative agents for pancreatic cancer.…”

Section: Introductionmentioning

confidence: 99%

Fixed Dose Rate Infusion of Gemcitabine with Oral Doxifluridine and Leucovorin for Advanced Unresectable Pancreatic Cancer: A Phase II Study

Kim

Park²,

Shin³

et al. 2007

Chemotherapy

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The standard beneficial chemotherapy proven for patients with advanced pancreatic cancer is a regimen containing gemcitabine. In the pregemcitabine era, 5-fluorouracil (5-FU) was the standard agent. Oral 5-FU can be added to gemcitabine to improve the efficacy of chemotherapy and to provide better patient convenience. The possibility to improve efficacy of gemcitabine by fixed dose rate infusion (FDRI) was proposed in addition to combining it with 5-FU. We tried a new chemotherapy combining FDRI of gemcitabine with doxifluridine and leucovorin. Eligibility criteria were pathologically proven, chemotherapy-naïve, and metastatic or nonoperable advanced pancreatic cancer. Gemcitabine 1,000 mg/m² was infused over 100 min (days 1, 8 and 15). Doxifluridine 200 mg/m² t.i.d. and leucovorin 15 mg b.i.d. were given orally (days 1–21). Chemotherapy was repeated every 28 days until a patient had received 6 cycles or progression was found. Twenty-nine patients were enrolled from October 2002 to December 2004. A total of 78 cycles were given at a mean of 2.7 cycles per patient. Response could be evaluated in 26 patients. Responses were partial remission in 4/26 patients (15.4%), stable disease in 8/26 (30.8%) and progression in 14/26 (53.8%). All patients progressed except for 2 in partial remission and 2 in stable disease. Toxicities could be assessed in 23 patients. Maximal hematological toxicities greater than grade 2 were leucopenia in 3 patients (11.5%), neutropenia in 2 (7.7%), anemia in 2 (7.7%), thrombocytopenia in 1 (3.8%) and febrile neutropenia in 3 (11.5%). Maximal nonhematological grade 3 or 4 toxicities were asthenia in 1 patient (3.8%), anorexia in 1 (3.8%), vomiting in 1 (3.8%), diarrhea in 2 (7.7%), allergic reaction in 1 (3.8%), hand-foot syndrome in 1 (3.8%) and hyperbilirubinemia in 1 (3.8%). All 29 patients were dead on last follow-up. Median progression-free survival was 3.91 months in 26 evaluable patients and median overall survival was 5.59 months in all patients. Combination chemotherapy including FDRI of gemcitabine seems minimally active for patients with advanced, nonoperable pancreatic cancer. Further research to improve effectiveness of chemotherapy for advanced pancreatic cancer is mandatory.

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Combined modality treatment of localized unresectable adenocarcinoma of the pancreas

Cited by 65 publications

References 18 publications

Clinical Investigations Perioperative high dose rate (HDR) brachytherapy in unresectable locally advanced pancreatic tumors

Clinical Investigations Perioperative high dose rate (HDR) brachytherapy in unresectable locally advanced pancreatic tumors

A Phase I Study of Eniluracil/5-FU in Combination with Radiation Therapy for Potentially Resectable and/or Unresectable Cancer of the Pancreas and Distal Biliary Tract

Fixed Dose Rate Infusion of Gemcitabine with Oral Doxifluridine and Leucovorin for Advanced Unresectable Pancreatic Cancer: A Phase II Study

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