Adjuvant radiotherapy and concomitant 5-fluorouracil by protracted venous infusion for resected pancreatic cancer

Purpose: To assess the toxicity and clinical benefit from adjuvant chemorad iotherapy consisting of protracted venous infusion 5-fluorouracil (5-FU) an d concomitant radiotherapy in patients with resected pancreatic cancer. Methods and Materials: Between 1994 and 1999, 52 patients who underwent pan creaticoduodenectomy received adjuvant chemoradiotherapy. The tumor bed and regional nodes received a dose of 45 Gy in fractions of 1.8 Gy followed by boost to the tumor bed if the surgical margins were involved (total dose, 54 Gy). The patients also received concomitant 5-FU by protracted venous in fusion (200-250 mg/m(2)/day, 7 days/week) during the entire radiotherapy co urse. Results: Fifty-two patients (30 men, 22 women) were enrolled and treated on this protocol. The median age was 63 years (range, 38-78 years), and the m edian Karnofsky Performance Status was 80 (range, 70-100). Thirty-five perc ent had involved surgical margins and 59% had involved lymph nodes. All pat ients completed therapy, and there were no Grade IV/V toxicities observed. With median follow-up of 24 months (range, 3-52 months) for surviving patie nts, the median survival is 32 months, and 2-year and 3-year survivals are 62%, and 39%, respectively. Conclusion: Radiotherapy with concomitant 5-FU by protracted venous infusio n as adjuvant treatment for resected pancreatic cancer is well tolerated. T his approach allows for greater dose intensity with reduced toxicity. The m edian survival of this cohort of patients compares favorably with our earli er experience and other published series. (C) 2000 Elsevier Science Inc.