Survival benefits of adjuvant chemotherapy with oral doxifluridine (5 '-DFUR) following radiotherapy in patients with unresectable pancreatic cancer

Background and Objectives: The combination of 5-fluorouracil and radiothera py is thought to be the most effective treatment for locally unresectable p ancreatic carcinoma. The outcomes, however, are far from acceptable from th e viewpoint of long-term survival. We assessed the survival benefits of ora l adjuvant chemotherapy with doxifluridine (5'-DFUR) following radiotherapy for patients with the disease. Methods: Thirty-five consecutive patients who underwent bypass surgery and radiotherapy for localized advanced unresectable adenocarcinoma of the panc reas head were retrospectively reviewed in regard to disease progression an d survival. Ten of the 35 patients underwent adjuvant chemotherapy with 5'- DFUR after radiotherapy in an outpatient setting. Results: The 1-year survival for patients treated with radiotherapy alone w as 29%. The 1-, 2-, and 3-year survivals for patients treated with the adju vant chemotherapy after radiotherapy were 50, 40, and 30%, respectively (P = 0.0069, log-rank test). The elevation of tumor markers was delayed (P = 0 .0346) and local control rate was improved (P = 0.0475) in patients with ch emotherapy. Multivariate analysis demonstrated that the adjuvant chemothera py with 5'-DFUR was a significant independent prognostic factor as well as tumor size. Conclusions: The adjuvant chemotherapy with 5'-DFUR following radiotherapy led to a significant prolongation of the survival for patients with unresec table localized pancreatic cancer. (C) 2001 Wiley-Liss, Inc.