Locally Advanced Pancreatic Cancer Treated with Radiation and 5-Fluorouracil: A First Step to Neoadjuvant Treatment?

Abstract

Aim of the Study: In two institutions, a retrospective analysis was performed on patients with histologically proven locally advanced pancreatic cancer without distant metastases. The aim of this analysis is to assess whether chemoradiotherapy provides survival benefit for patients with locally advanced pancreatic cancer. Methods: Forty-five patients from the Erasmus Medical Centre (Erasmus MC), Rotterdam, received 5-fluorouracil (5-FU) and radiotherapy and, 38 patients from the Academic Medical Centre Amsterdam (AMC) were offered the best supportive care. Radiotherapy consisted of 50 Gy external upper abdomen radiation in two courses, concomitant with intravenous 5-FU 25 mg/kg/ 24 h continuously on the first 4 days of each treatment course. Results: The treatment protocol was completed in 38 of 45 patients (84%) without complications. Radiological response was evaluated in 38 patients. Ten patients (26%) showed a partial response, stable disease was seen in 6 (16%) patients and progressive disease in 22 (58%) patients. A second-look operation was performed in 8 of 10 patients (72%) showing a radiological response, in 3 patients the tumour could be resected. Median overall survival time for the Erasmus MC group (n = 45) was 9.8 months compared to 7.6 months when the best supportive care was given (AMC group, p = 0.04). Conclusion: Although overall survival remains poor, treatment with 5-FU and radiotherapy might benefit some patients with locally advanced pancreatic cancer.

The challenge of pancreatic cancer therapy and novel treatment strategy using engineered mesenchymal stem cells

“…4 The number of newly diagnosed patients nearly equals that of the deceased; no current treatment, whether surgical, chemotherapy or a combination thereof, results in an effective clinical response in more than 20% of patients and no treatment therapies have been found that extend survival beyond a few months. Clinically, pancreatic cancer presents in up to 50% at a locally advanced stage and, in up to 40% with metastatic disease, 5 dramatically reducing the chance of curative resection. Factors such as age, smoking, past medical history, and other conditions such as diabetes and pancreatitis have been associated risk factors of pancreatic cancer.…”

Preoperative gemcitabine based chemo-radiotherapy in locally advanced non metastatic pancreatic adenocarcinoma

“…On the other hand, our figures are higher than those reported by Smeenk et al . [ 7 ] who stated that only 42% (16 out of 38) of patients showed radiographic evidence of response (26% PR & 16% SD). This difference may result from the use of fluorouracil and not gemcitabine based chemoradiation in the reported series in constrast to our study, where gemcitabine based chemoradiotherapy was used.…”

Pancreas Cancer Survival in the Gemcitabine Era

“…With respect to radiotherapy, results of clinical trials have been mixed, (1987; Klinkenbijl, Jeekel et al 1999; Neoptolemos, Stocken et al 2004; Smeenk, de Castro et al 2005; Stocken, Buchler et al 2005; Garofalo, Regine et al 2006; Sultana, Neoptolemos et al 2006; Saif 2007; Smeenk, van Eijck et al 2007; Artinyan, Hellan et al 2008) with divergent opinions concerning the same study being published. (Klinkenbijl, Jeekel et al 1999; Garofalo, Regine et al 2006) For this reason, radiotherapy continues to be viewed as an option to be reserved for research protocols and specialized centers.…”