Radiotherapy and continuous infusion 5-fluorouracil in patients with nonresectable pancreatic carcinoma

Purpose: The current standard local treatment for nonresectable pancreatic carcinoma is radiotherapy (RT) with concurrent 5-fluorouracil (5-FU); howev er, the optimal schedule for 5-FU administration has not been fully establi shed. In this study, we report on our experience with the combination of RT and continuous infusion 5-FU in a group of patients with locally nonresect able pancreatic carcinoma. Methods and Materials: Forty-two patients with adenocarcinoma of the pancre as were enrolled in a prospective clinical trial. RT was delivered using a four-field technique to a total dose of 59.4 Gy in 33 fractions. 5-FU was g iven through a central venous catheter at a dose of 300 mg/m(2)/day, 7 d/wk , throughout the entire course of RT. Results: All patients completed the RT as planned, and 33 (78%) completed t he full regimen of chemotherapy. Ten patients (23%) had a partial response, and 32 (77%) had stable disease. Subjective response, defined as the disap pearance of symptoms observed at diagnosis, was also evaluated. Two patient s (6%) had a complete, and 24 (75%) a partial, remission of symptoms. The m edian time to progression was 6.2 months, and the median survival time was 9.1 months. Conclusions: In terms of local control, the results of our study, with RT a nd protracted 5-FU infusion, compare well with those of other studies using RT and bolus 5-FU. The control of distant metastatic disease remains an op en issue. However, the palliation of symptoms achieved by our treatment sch edule in patients with a very poor prognosis and severe symptoms may be reg arded as a positive result. (C) 2001 Elsevier Science Inc.