PROTRACTED 5-FLUOROURACIL INFUSION WITH CONCURRENT RADIOTHERAPY AS A TREATMENT FOR LOCALLY ADVANCED PANCREATIC-CARCINOMA

BACKGROUND. Radiotherapy plus bolus 5-fluorouracil (5-FU) is generally accepted as the standard treatment for locally advanced pancreatic ca rcinoma. To intensify the antitumor effect of chemotherapy, the author s administered protracted 5-FU infusion with concurrent radiotherapy. The aim of this study was to determine the feasibility and effectivene ss of this combined therapy. METHODS. Twenty patients, all of whom had histologically confirmed exocrine pancreatic carcinoma that was nonre sectable but confined to the pancreatic region, were enrolled in a Pha se II trial of protracted 5-fluorouracil infusion (200 mg/m(2)/day) wi th concurrent radiotherapy (50.4 gray in 28 fractions over 5.5 weeks). Chemotherapy began on the first day of radiation and continued throug h the entire radiation course. Thereafter, weekly infusions (500 mg/m( 2)) were administered until disease progression. RESULTS. Of the 20 pa tients, 17 (85%) completed the scheduled course of chemoradiotherapy. Grade 3 or worse toxicity, graded according to World Health Organizati on criteria, was observed in 4 patients (20%). Two patients (10%) achi eved partial response, and disease remained stable in 16 patients (80% ). After the completion of combined therapy, serum CA 19-9 levels were reduced by more than 50% in 10 of 12 patients (83%) who had pretreatm ent CA 19-9 levels of 100 U/mL or greater. The median progression free survival and 1-year progression free survival rate were 4.9 months an d 29.5%, respectively. The median overall survival and 1-year overall survival rate were 10.3 months and 41.8%, respectively. CONCLUSIONS. T his treatment showed moderate activity against locally advanced pancre atic carcinoma and was accompanied by an acceptable toxicity level. (C ) 1997 American Cancer Society.