International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: pancreasLength and quality of survival after external-beam radiotherapy with concurrent continuous 5-fluorouracil infusion for locally unresectable pancreatic cancer
Introduction
Pancreatic cancer is a morbid disease with a dismal prognosis. At present, complete surgical resection offers the best chance of cure 1, 2, 3. However, because of the invasion of major vessels or the presence of metastasis, most pancreatic cancers are already unresectable at the time of diagnosis 4, 5. Without surgical intervention, the mean length of survival is approximately 6 months. Thus, in the majority of patients, optimal palliation of symptoms is of primary importance, to maximize the quality of remaining life 6, 7, 8. Consequently, many studies have recommended radiation therapy and/or chemotherapy as the primary treatment for patients with unresectable tumors of the pancreas. For patients with locally unresectable disease, the results of previous randomized trials by the Gastrointestinal Tumor Study Group indicated that concurrent external-beam radiation therapy (EBRT) and bolus 5-fluorouracil (5-FU) therapy resulted in significantly better survival compared with EBRT alone or chemotherapy alone 9, 10. Recently, radiation has been employed concurrently with systemic, continuous infusion of 5-FU chemotherapy as a radiation sensitizer 11, 12.
We have delivered EBRT with concurrent continuous 5-FU chemotherapy since 1997. In this study, we performed a randomized trial of locally unresectable pancreatic cancer cases. The length and quality of survival of patients who were treated with EBRT plus concurrent continuous 5-FU chemotherapy was compared to the length and quality of survival of those who received no chemoradiotherapy.
Section snippets
Patients
Between January 1997 and June 2000, 31 patients were enrolled in a prospective randomized study at the Kagoshima University Hospital in Kagoshima, Japan. Fifteen of the patients were male, and the mean age of all patients was 64 years (range: 22–82 years). All patients had locally advanced and unresectable pancreatic cancer without distant metastases. Histologic or cytologic confirmation of pancreatic adenocarcinoma was established in all patients. Tumors were considered to be unresectable
Length of survival
The length of survival of all 31 patients ranged from 2.0 to 16.9 months. The mean and median lengths of survival and 1-year survival rate for all 31 patients were 8.5 months, 8.2 months, and 29.6%, respectively. The length and quality of survival for patients in both groups are summarized in Table 2. The mean survival of 10.7 months in the chemoradiation group was significantly longer than the mean survival of 6.2 months in the no-therapy group (p = 0.001). In addition, the median survival of
Discussion
Earlier trials performed by the Gastrointestinal Tumor Study Group established roles for 5-FU chemotherapy and EBRT in the treatment of patients with resectable or locally advanced pancreatic cancer 9, 10, 17, 18. Since then, EBRT concurrent with 5-FU has been generally accepted as the standard treatment for locally advanced pancreatic cancer 19, 20, 21, 22. In all the studies noted above, 5-FU was administered by bolus injection as a radiation sensitizer. Recently, the Eastern Cooperative
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