Multimodality therapy of localized unresectable pancreatic adenocarcinoma

Abstract

Eighty‐eight patients with localized unresectable carcinoma of the pancreas were treated at Thomas Jefferson University Hospital between 1974 and 1981. Four treatment regimens were used which were sequential modifications of the technique based on the experience in the preceeding group of patients. Each treatment changed the course of the disease, and as patterns of failure were identified, the treatment was altered to deal with them. Initially, all patients were treated with external beam radiation. Subsequently, Iodine‐125 implantation was added to improve local control; low‐dose preoperative radiotherapy to reduce the risk of peritoneal seeding; and adjuvant chemotherapy to reduce the risks of distant metastases. The addition of 125I implantation increased the local control from 22% to 81%, but did not increase the median survival, which was unchanged from 7 months. The addition of adjuvant chemotherapy increased the median survival from 7 months to 14 months, but had no impact on the control of the pancreatic tumor. Adjunctive chemotherapy and low‐dose preoperative radiotherapy appear synergistic in reducing the risk of peritoneal seeding. The combination of 125I implantation, external beam radiation, and adjunctive chemotherapy is safe and effective. This regimen produces excellent local control with acceptable morbidity. This regimen produced a 30% survival at 18 months. The patterns of failure among these patients suggest future modifications of the technique.

Gemcitabine with a specific conformal 3D 5FU radiochemotherapy technique is safe and effective in the definitive management of locally advanced pancreatic cancer

“…Since local progression is often characterised by severe, difficult-to-control neuropathic pain, we see this outcome as an important measure of efficacy of this approach. Older studies of radiochemotherapy in patients with locally advanced pancreatic cancer have had local failure rates of 58, 72, and 78% (Whittington et al, 1984;Gastrointestinal Tumor Study Group, 1985;Roldan et al, 1988). More recent studies of radiochemotherapy have tended not to report duration of local control but rather first site of relapse, with local relapse being uncommon as the first site in treated patients (Blackstock et al, 2003), which makes comparison and interpretation of the potential impact of radiotherapy more difficult.…”

Intraoperative Radiation Therapy Combined with Hyperthermia against Pancreatic Carcinoma.

“…Many institutes tried this TORT method and excellent pain relief is reported (Nishimura et al 1984;Miyoshi et al 1985). However, patient's prognosis was not improved because of high incidence of local failure and metastasis (Whittington et al 1984 ;Gunderson et al 1987 ;Roldan et al 1988). We tried hyperthermia combined with the TORT.…”

“…There was no difference in survival rate by tumor staging, radiation dose and with or without post operative irradiation. The reason why improved local control due to TORT doesn't produce better survival is that pancreatic carcinoma has a high incidence of metastasis from the early stage (Whittington et al 1984;Gunderson et al 1987). Gunderson et al (1987) are trying upper abdominal wide field irradiation to control metastasis.…”

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

“…Whittington et al . provided an evidence that in the case of radiotherapy alone, local control on tumor development was achieved in 22% of patients, while with the additional brachytherapy performed the results grew to 81% [33]. A similar influence on tumor growth was confirmed by Shipley et al .…”