Treatment of locally advanced pancreatic cancer with concurrent
uftoral and radiotherapy. Results from 64 patients treated from
2008 ASCO Annual Meeting
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
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.
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.
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