This Article Full Text (PDF) eLetters: Submit a response to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article link to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bronn, D. G. Search for Related Content PubMed Articles by Bronn, D. G.

Multimodality Management of Pancreatic Cancer

Michigan Institute for Radiation Oncology, 70 Fulton Street, Pontiac, MI 48341-2755

Many patients with a diagnosis of pancreatic cancer are not offered any therapeutic intervention other than surgical bypass due to very poor prognosis, poor patient tolerance to current therapeutic regimens, and a dismal tumor response to therapy. In view of these circumstances, an acceptable treatment regimen for pancreatic cancer must first demonstrate an ability to obtain a rapid tumor response with a regimen that will be well tolerated enabling the patient to maintain a good quality of life with full ambulatory status. The following multimodality trial was, therefore, undertaken in collaboration with my colleagues: Roman Franklin, M.D., Rajan S. Krishnan, M.D., Ralph W. Richardson, M.D. and Christopher Conlin, M.D.

Nine unresectable pancreatic cancer patients (4/9 had liver metastases) with an average age of 62 (range: 41-79) were treated with a concurrent regimen consisting of continuous infusion 5-fluorouracil (200-250 mg/m²/24 h) and continuous infusion cisplatin (5mg/24 h: 2 weeks on, 1 week off) given simultaneously with 3-D planned BID hyperfractionated radiotherapy to the pancreas (5940 cGy/66 fractions/6.5 weeks), and whole liver (1980 cGy/22 fractions/2 weeks), plus additional dose to the partial liver in metastatic disease. Continuous infusion combination chemotherapy was continued alone after radiotherapy for a total of six months. Chemotherapy was delivered by dual lightweight portable external pumps. Hyperalimentation was used as needed to maintain nutritional status and warfarin thromboembolic prophylaxis was also utilized. Tumor response was monitored by monthly abdominal CAT scans, serum markers (CEA, CA 19-9), weight gain, and symptomatology. Full radiographic resolution of tumor mass was considered to be a complete response (CR), whereas 50% or greater radiographic decrease in size was considered a partial response (PR). Evaluation was done by independent diagnostic radiologists.

CR and PR of the pancreatic mass were achieved in 88% of all patients (8/9). CR was achieved in 44% of all patients (4/9). Patients with liver metastases exhibited 75% (3/4) PR in liver masses and either CR or PR in the primary site. All radiographic responses were achieved within one to three months after completion of the radiotherapy portion of the concurrent treatment regimen. One-year survival was achieved in 78% of patients treated (7/9). Two-year survival was achieved in 44% of patients treated (4/9). These response and survival rates were achieved with minimal complications and side-effects and patients predominantly maintained ambulatory status throughout the entire course of treatment and follow-up.

Concurrent continuous infusion combination chemotherapy in low daily doses with BID hyperfractionated radiotherapy is effective in achieving dramatic local response and improved survival with minimal side-effects. These results suggest that a significant synergistic effect exists with concurrent chemoradiotherapy in complimentary low-dose regimens for the treatment of pancreatic cancer. Additional studies are suggested for further exploration of the optimal integration of well-tolerated concurrent chemoradiation combinations; however, it is evident that concurrent chemoradiotherapy is significantly superior to chemotherapy alone in the treatment of advanced pancreatic cancer.

This Article Full Text (PDF) eLetters: Submit a response to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article link to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bronn, D. G. Search for Related Content PubMed Articles by Bronn, D. G.