Treatment of locally advanced pancreatic cancer with concurrent uftoral and radiotherapy. Results from 64 patients treated from

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Treatment of locally advanced pancreatic cancer with concurrent
uftoral and radiotherapy. Results from 64 patients treated from
2001-2005.

2008 ASCO Annual Meeting

Abstract No:4624

J Clin Oncol 26: 2008 (May 20 suppl; abstr 4624)

J. K. Bjerregaard, K. R. Schønnemann, H. A. Jensen, M. B. Mortensen, T. P. Hansen, P. Pfeiffer

Abstract:
Background:
Definition and treatment options for locally advanced non-resectable
pancreatic cancer (LAPC) vary. Treatment options range from palliative
chemotherapy to radiochemotherapy (RCT). LAPC is typically
non-resectable due to invasion of adjacent structures, mainly the
mesenteric vessels or the portal vein. Several studies have shown that
a number of patients become resectable after treatment.
Methods:
From 2001 to 2005, we have treated 64 consecutive patients with RCT for
LAPC. Patients were staged prior to RCT with endoscopic ultrasound
(EUS), laparoscopic ultrasound (LUS) and/or multi-sliced CT. LUS was
used in all patients prior to surgery. Patients with invasion of the
celiac trunk, superior mesenteric artery/vein, portal vein or venous
confluence were considered non-resectable. Treatment consisted of
uftoral (UFT) (300 mg/m²/day) given orally on all radiation days.
Radiation dose was 50 Gy/27 fractions. GTV was defined as tumour tissue
on the therapeutic scan, including all pathological lymph nodes. CTV
was defined as GTV + 2 cm. Standard 3-4 field techniques were used.
Evaluation of response was performed 4-6 weeks after completion of RCT,
with multi sliced CT, EUS and/or LUS. If the tumour was deemed
resectable, operation was performed.
Results: 64 patients were
uniformly treated with RCT, 59 patients (92%) completed all 27
fractions. Toxicity was generally mild, with 10 patients (16%)
experiencing toxicity CTC grade 3 or worse. One patient developed
severe gastro- enteritis and died of pneumonia one week after
completion of RCT. Two patients had grade 4 upper GI bleeding during
and 1 week following RCT, respectively. Median survival for the entire
group was 11.9 (8.7-13.3) months. Eleven patients underwent resection,
leading to a resection rate of 17% following RCT with a median survival
of 43.7 (22.9-nr) months in resected patients. All 11 patients had a R0 
resection. One patient was resectable, but refused surgery. Median
survival for the patients without resection was 9.0 (7.8-12.1) months.
Conclusion:
RCT with 50 Gy combined with UFT, is a well-tolerated and effective
treatment for patients with LAPC. R0 resection was possible in 17%
leading to an impressive median survival of 43.7 months in resected
patients.