Combined radiotherapy and chemotherapy (cisplatin and 5-fluorouracil) as palliative treatment for localized unresectable or adjuvant treatment for resected pancreatic adenocarcinoma: Results of a feasibility study

Purpose: To evaluate a cisplatin-containing chemoradiotherapy (CRT) regimen followed by chemotherapy for unresectable (locally advanced group, n = 32) and resected (adjuvant group, n = 10) pancreatic adenocarcinoma. The quali ty of palliation and percentage of secondary resections were also studied f or unresectable disease. Methods and Materials: The protocol comprised CRT (45 Gy over 5 weeks), com bined with 5-fluorouracil and cisplatin during the first and fifth weeks, f ollowed, 3 weeks later, by 4 cycles of the same chemotherapy plus leucovori n. Results: All patients completed CRT but only 50% of each group finished the entire protocol. Gastrointestinal toxicity and weight loss were the major side effects during CRT. Enhanced hematological toxicity limited the post-C RT chemotherapy. For the locally advanced group, median survival was 9 mont hs; 1- and 2-year survival rates were 31 and 12.5%, respectively. The overa ll response rate was 16% and 50% had stable disease. A lasting palliative e ffect defined as improved performance status and decreased analgesic consum ption, was recorded for 43% of the patients. Only three secondary resection s have been performed. For the adjuvant group, median survival was 17 month s. Conclusions: Although toxic in advanced disease, this regimen significantly lowered pain and analgesic consumption, but had poor impact on secondary r esectability. In an adjuvant setting, although equally toxic, this series w as too small to allow conclusions to be drawn. (C) 2000 Elsevier Science In c.