Protracted venous infusion 5-fluorouracil with concomitant radiotherapy compared with bolus 5-fluorouracil for unresectable pancreatic cancer

Radiation therapy (RT) with concurrent 5-fluorouracil (5-FU) administered b y protracted venous infusion (PVI) replaced our prior institutional protoco l of RT with bolus administration of 5-FU as standard therapy for unresecta ble pancreatic cancer in 1994. In this article, we compare the treatment in tensity, toxicity, and outcome for patients with unresectable pancreatic ca ncer treated on these sequential protocols. Fifty-four patients, 27 on each protocol, with biopsy-confirmed pancreatic cancer received chemoradiothera py. The radiotherapy field included the gross tumor volume and regional lym ph nodes to a dose of 45 Gy, followed by "boost" to the gross tumor volume to 54 Gy to 60 Gy. From 1987 to 1994, patients received concurrent 5-FU adm inistered by bolus injection, at a dose of 500 mg/m(2) on days 1 to 3 and d ays 29 to 31 of RT, After December 1994, 5-FU was administered by PVI (200- 250 mg/m(2)) beginning on day 1 and continuing until the completion of RT. The chemotherapy treatment intensity was increased in the group receiving 5 -FU by PVI, as evidenced by an increased average weekly and cumulative dose of 5-FU (p < 0.01). The radiotherapy treatment intensity was equivalent be tween the two groups. The incidence of objectively quantified toxicity was not statistically different between treatment groups. Overall survival rema ined poor in both treatment groups. With a median follow-up of 18 months (r ange: 3-30 months) for surviving patients, the 6-month, 1-year, and 2-year survivals for the PVI 5-FU-treated group versus the bolus 5-FU-treated grou p were 56% versus 52%, 34% Versus 18%, and 22% versus 13%, respectively (p = 0.9). Radiotherapy with concomitant 5-FU by PVI results in a greater week ly and total dose of chemotherapy. The method of 5-FU administration (bolus versus PVI) did not change the RT treatment intensity, experienced toxicit y, or overall survival.