This site uses cookies, tags, and tracking settings to store information that help give you the very best browsing experience. Dismiss this warning

The Current Status of Combined Radiotherapy and Chemotherapy for Locally Advanced or Resected Pancreas Cancer

Authors:
Mary F. Mulcahy Department of Radiology, Division of Hematology/Oncology and the Division of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois

Search for other papers by Mary F. Mulcahy in
Current site
Google Scholar
PubMed
Close
 MD
,
Andrew O. Wahl Department of Radiology, Division of Hematology/Oncology and the Division of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois

Search for other papers by Andrew O. Wahl in
Current site
Google Scholar
PubMed
Close
 MD
, and
William Small Jr. Department of Radiology, Division of Hematology/Oncology and the Division of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois

Search for other papers by William Small Jr. in
Current site
Google Scholar
PubMed
Close
 MD
Full access

Pancreas cancer is the fourth most common cause of cancer deaths. Even for the small percentage of patients who can undergo surgical resection of the primary tumor, the risk of recurrence remains unacceptably high. For patients with localized disease that is not amenable to surgical resection, pain related to the primary tumor can significantly impair quality of life. Attempts to improve the duration and quality of life for these patients have included both chemotherapy and radiotherapy. The addition of chemotherapy to radiation may enhance the local effects of radiation or provide treatment of disease outside the radiation field. The results of clinical trials evaluating the appropriate therapy for locally advanced or resected disease have been inconsistent. In some instances, the methods used in these studies became outdated before the results were available. Hopefully, advances in radiation techniques and systemic drug therapy will provide more durable and clinically relevant results. Meanwhile, treatment decisions should be tailored to the clinical situation, including consideration of treatment toxicity and therapy goals. Recognizing which patients are likely to benefit from combination therapy or systemic therapy alone is a subject of future and ongoing clinical trials.

Correspondence: Mary F. Mulcahy, MD, Department of Medicine, Division of Hematology/Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, 676 North Saint Clair, Suite 850, Chicago, IL 60611. E-mail: m-mulcahy@northwestern.edu
  • Collapse
  • Expand
  • 1

    Jemal A, Murray T, Ward E et al.. Cancer statistics, 2005. CA Cancer J Clin 2005:55:1030.

  • 2

    Burris HA 3rd, Moore MJ, Anderson J et al.. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 1997;15:24032413.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Neoptolemos JP, Stocken DD, Friess H et al.. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004;350: 12001210.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Neuhaus POH, Post S, Gellert K et al.. A randomised, prospective, multicenter, phase III trial of adjuvant chemotherapy with gemcitabine vs. observation in patients with resected pancreatic cancer. J Clin Oncol 2005;23(suppl): 1092S.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Tepper J, Nardi G, Sutt H. Carcinoma of the pancreas: review of MGH experience from 1963 to 1973. Analysis of surgical failure and implications for radiation therapy. Cancer 1976;37:15191524.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Griffin JF, Smalley SR, Jewell W et al.. Patterns of failure after curative resection of pancreatic carcinoma. Cancer 1990;66:5661.

  • 7

    Whittington R, Bryer MP, Haller DG et al.. Adjuvant therapy of resected adenocarcinoma of the pancreas. Int J Radiat Oncol Biol Phys 1991;21:11371143.

  • 8

    Abrams RA. Adjuvant therapy for pancreatic adenocarcinoma: what have we learned since 1985? Int J Radiat Oncol Biol Phys 2003;56(suppl):39.

  • 9

    Kao GD, Whittington R, Coia L. Anatomy of the celiac axis and superior mesenteric artery and its significance in radiation therapy. Int J Radiat Oncol Biol Phys 1993;25: 131134.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Komaki R, Wadler S, Peters T et al.. High-dose local irradiation plus prophylactic hepatic irradiation and chemotherapy for inoperable adenocarcinoma of the pancreas. A preliminary report of a multi-institutional trial (Radiation Therapy Oncology Group Protocol 8801). Cancer 1992;69:28072812.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Hall EJ. Radiobiology for the Radiologist, 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins 2000; pp 1731.

  • 12

    Lawrence TS, Tepper JE, Blackstock AW. Fluoropyrimidine-radiation interactions in cells and tumors. Semin Radiat Oncol 1997;7:260266.

  • 13

    Steren A, Sevin BU, Perras J et al.. Taxol sensitizes human ovarian cancer cells to radiation. Gynecol Oncol 1993;48:252258.

  • 14

    Shewach DS, Lawrence TS. Radiosensitization of human solid tumor cell lines with gemcitabine. Semin Oncol 1996;23(Suppl 10):6571.

  • 15

    Moertel CG, Frytak S, Hahn RG et al.. Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil: The Gastrointestinal Tumor Study Group. Cancer 1981;48:17051710.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Gastrointestinal Tumor Study Group. Treatment of locally unresectable carcinoma of the pancreas: comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone. J Natl Cancer Inst 1988;80:751755.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Gastrointestinal Tumor Study Group. Radiation therapy combined with adriamycin or 5-fluorouracil for the treatment of locally unresectable pancreatic carcinoma. Cancer 1985;56:25632568.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Seydel HG, Stablein DM, Leichman LP et al.. Hyperfractionated radiation and chemotherapy for unresectable localized adenocarcinoma of the pancreas. The Gastrointestinal Tumor Study Group experience. Cancer 1990;65:14781482.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Whittington R, Neuberg D, Tester WJ et al.. Protracted intravenous fluorouracil infusion with radiation therapy in the management of localized pancreaticobiliary carcinoma: a phase I Eastern Cooperative Oncology Group Trial. J Clin Oncol 1995;13:227232.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Osti MF, Costa AM, Bianciardi F et al.. Concomitant radiotherapy with protracted 5-fluorouracil infusion in locally advanced carcinoma of the pancreas: a phase II study. Tumori 2001;87:398401.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Boz G, De Paoli A, Innocente R et al.. Radiotherapy and continuous infusion 5-fluorouracil in patients with nonresectable pancreatic carcinoma. Int J Radiat Oncol Biol Phys 2001;51:736-740.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Kalser MH, Ellenberg SS. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 1985;120:899903.

  • 23

    Gastrointestinal Tumor Study Group. Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Cancer 1987;59:20062010.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Klinkenbijl JH, Jeekel J, Sahmoud T et al.. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 1999;230:776782; discussion 782–784.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Crane C, Ben-Josef E & Small W. Jr. Chemotherapy for pancreatic cancer. NEJM 2004;350:27132715.

  • 26

    Picozzi VJ, Kozarek RA, Traverso LW. Interferon-based adjuvant chemoradiation therapy after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am J Surg 2003;185:476480.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Blackstock AW, Tepper JE, Niedwiecki D et al.. Cancer and leukemia group B (CALGB) 89805: phase II chemoradiation trial using gemcitabine in patients with locoregional adenocarcinoma of the pancreas. Int J Gastrointest Cancer 2003;34:107116.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Talamonti MS, Catalano PJ, Vaughn DJ et al.. Eastern Cooperative Oncology Group Phase I trial of protracted venous infusion fluorouracil plus weekly gemcitabine with concurrent radiation therapy in patients with locally advanced pancreas cancer: a regimen with unexpected early toxicity. J Clin Oncol 2000;18:33843389.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    McGinn CJ, Zalupski MM, Shureiqi I et al.. Phase I trial of radiation dose escalation with concurrent weekly full-dose gemcitabine in patients with advanced pancreatic cancer. J Clin Oncol 2001;19:42024208.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Talamonti MS, Small W Jr., Mulcahy MF et al.. A Multi-Institutional Phase II Trial of Preoperative Full Dose Gemcitabine and Concurrent Radiation for Patients with Potentially Resectable Pancreatic Carcinoma. Ann Surg Oncol, October 2005 in press.

    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 1607 831 100
PDF Downloads 276 84 12
EPUB Downloads 0 0 0