Feasibility and efficacy of high dose conformal radiotherapy for patients with locally advanced pancreatic carcinoma

BACKGROUND. The feasibility and efficacy of high dose conformal radiotherap y were examined in the treatment of patients with locally advanced, unresec table pancreatic carcinoma. METHODS. Forty-four patients with pathologically confirmed, unresectable pa ncreatic adenocarcinoma without distant metastases were treated in a Phase II study. The patients received three-dimensional, planned, high dose confo rmal radiotherapy (70-72 grays). Toxicity was scored according to the World Health Organization criteria. Follow-up time ranged from 7 months to 25 mo nths (median, 9 months). RESULTS. The treatment was feasible. Forty-one patients received the intend ed total dose. Treatment was never stopped because of toxicity. Acute toxic ity was mainly Grade 1 and Grade 2 (in 70% and 57% of patients, respectivel y), whereas Grade 3 toxicity was seen in 9% of patients. One fatal event oc curred that was not treatment related. Late Grade 3 and Grade 4 gastrointes tinal toxicity was seen in 3 patients and 2 patients, respectively. Late (G rade 5) gastrointestinal bleeding was observed in 3 patients, 2 of whom had local tumor progression. At 3 months, reduction in tumor size was seen in 27% of patients, stable disease was seen in 20% of patients, and local dise ase progression was seen in 40% of patients. Ultimately, local disease prog ression was observed in 44% of patients. No true partial or complete respon ses were documented. The median survival from the time of diagnosis was 11 months (10 months from the start of radiotherapy). Seventeen of 25 patients (68%) experienced pain relief. CONCLUSIONS. High dose conformal radiotherapy for the treatment of patients with locally advanced pancreatic carcinoma is feasible with acceptable tox icity. In case of pain, it can offer palliation. The efficacy of the treatm ent in terms of prolongation of life is not proven. Distant metastases rema in the major problem. Cancer 2000;89:2222-9. (C) 2000 American Cancer Socie ty.