Treatment of unresectable, locally advanced pancreatic adenocarcinoma with combined radiochemotherapy with 5-fluorouracil, leucovorin and cisplatin

Abstract

The aim of the study was to evaluate the effectiveness and safety of a combined treatment modality including systemic chemotherapy with 5-fluorouracil (FU), leucovorin, cisplatin and external beam radiotherapy in patients with locally advanced pancreatic cancer. Systemic chemotherapy consisted of FU 400 mg m −2 and leucovorin 20 mgm −2 both given as intravenous bolus injection on days 1–4, plus cisplatin 20 mgm −2 administered as 90-min infusion on days 1–4. Treatment courses were repeated every 4 weeks × 6 unless prior evidence of progressive disease. Radiation therapy using megavolt irradiation of ≥ 6 MV photons with a 3- or 4-field technique was delivered during the second and third chemotherapy course, that was reduced in dose by 25%. Between October 1994 and July 1996, a total of 38 patients were entered onto this trial, all of whom were assessable for toxicity and survival. Eighteen of these (47%) had objective remissions to combined radiochemotherapy, including four CR (11%), 13 (34%) had stable disease and seven patients (18%) showed tumour progression during treatment. The median progression-free interval of the entire study population was 10 months (range 3–32), and median overall survival was 14.0 months (range 3–45+ months); 53% of all patients were alive at 12 months, and 18% of patients were alive at 24 months respectively. Severe haematological side-effects comprised neutropenia in 18%, thrombocytopenia in 8% and anaemia in 11%. The most frequent non-haematological side-effects were nausea/vomiting (WHO grade 3: 18%), and diarrhoea (grade 3: 13%). This combined radiochemotherapy regimen was tolerable and effective in patients with locally advanced pancreatic cancer. Since therapeutic results, in fact, compare favourably with other series, including surgical treatment of potentially resectable tumours, further evaluation of combined treatment modalities in the neoadjuvant setting seems warranted. © 2000 Cancer Research Campaign

Treatment of Non-Resectable Pancreatic Cancer With 5-Fluorouracil, Leucovorin and Mitomycin-C

“…The complete response has continued for 36 months after the initial surgery. , 1996), leucovorin (Oman, Blind, Naredi et al, 2001;Huguier, Barrier, Valinas et al, 2001;Oettle, Arning, Pelzer et al, 2000;Andre, Balosso, Louvet et al, 2000;Kornek, Schratter-Sehn, Marczell et al, 2000;Link, Formentini, Papachristov et al, 1997;Raderer, Kornek, Hejna et al, 1997) and interferons were used with 5-FU as biochemical modulators, and epirubicin (Raderer , Kornek, Hejna et al, 1997), mitomycin, cyclophosphamide and many other agents were used in an attempt to gain synergistic effects . Weekly 5-FU with leucovorin, daily dipyridamole and intermittent mitomycin-C was reported to be effective palliative, neoadjuvant and adjuvant chemotherapy for pancreatic cancer Todd, Gloor, Lane et al, 1998).…”

“…Systemic chemotherapy is an alternative treatment for patients with advanced and unresectable pancreatic cancer and many clinical trials have been performed in an attempt to find the optimal anti-cancer drug regimen. The combination of 5-FU and leucovorin has been shown to have some anti-cancer effect in patients with advanced gastrointestinal and pancreatic cancer (Oman, Blind, Naredi et al, 2001;Huguier, Barrier, Valinas et al, 2001;Oettle, Arning, Pelzer et al, 2000;Andre, Balosso, Louvet et al, 2000;Kornek, Schratter-Sehn, Marczell et al, 2000). However, the results for pancreatic cancer were far from satisfactory with a maximal response rate of 20-30% with either mono-or combination therapy.…”

The Investigation of 125I Seed Implantation as a Salvage Modality for Unresectable Pancreatic Carcinoma

“…The data indicate that younger patients with good performance status, or treatment with gemcitabine-or capecitabine-based chemotherapy were favorable prognostic factors [35][36][37][38]. Multiple factors were analyzed using the log-rank single factor model, and the data suggested that patients who actually received a D 90 higher than 110 Gy and patients younger than 60 years may survive longer (p < 0.05).…”

Radioterapia em adenocarcinoma de pâncreas

“…A Tabela 4 mostra um levantamento da literatura a respeito, mostrando a sobrevida atuarial mediana variando de 5,7 meses a 14 meses e 0% a 18% dos pacientes como sobreviventes a longo prazo (mais de dois anos de sobrevida) 10,13,17,24,[26][27][28][29][30] . Embora a maioria destes estudos sugira haver benefício na introdução do tratamento adjuvante, um estudo multicêntrico francês concluiu que a radioterapia, mesmo aplicada em altas doses (60 Gy no caso) e associada à quimioterapia com cis-diaminodicloro-platina, teve um pequeno impacto no controle local do tumor e na sobrevida e somente um efeito moderado no alívio sintomático da dor 30 .…”