Neoadjuvant radio-chemotherapy in advanced primarily non-resectable carcinomas of the pancreas

Aim: To investigate the feasibility of neoadjuvant radio-chemotherapy (RCT) in the treatment of primarily nonresectable pancreas carcinoma the paramet ers tumour regression, possibility of subsequent resection and tolerability were examined. Method: Between 1995 and 1997, 27 patients with locally inoperable (assesse d by CT criteria) pancreatic carcinoma received radio-chemotherapy for 5 we eks comprising irradiation (55.8 Gy) and chemotherapy with 5-fluorouracil ( 5-FU. 1000 mg/m(2)/day; 120 h continuous infusion) and mitomycin C (10 mg/m (2) i.v.-bolus, day 2 and day 30) during the first and fifth week of radiot herapy. Two target volumes were irradiated with fractionated doses of 1.8 G y up to a total of 50.4 Gy. Radiation was applied once a day five times a w eek and target volume 1 was irradiated with the same fractionated dose, and an additional boost of 5.4 Gy to make an overall total of 55.8 Gy. Results: Sixteen patients underwent explorative laparotomy, 10 of these wer e resected (eight Whipple's procedures, two distal pancreatic resections), while six could not be resected due to peritoneal carcinosis (n = 3), local irresectability (n = 2) and liver cirrhosis (n = 1). A further nine patien ts were found to have unresectable tumours on CT and did not undergo surger y after restaging (five of these patients were staged as 'locally irresecta ble', three patients had distant metastases and one patient refused surgery ). In two patients RCT was abandoned because of progression of disease. Conclusions: The study protocol described is feasible without significant a cute toxicity and when used the resectability rare was improved; the surviv al rate, however, was not improved. Additional intra-arterial or intraporta l application of such drugs as mitomycin C or cisplatin may be necessary. ( C) 2000 Harcourt Publishers Ltd.