Initial systemic chemotherapy ( 6 months ) with a combination regimen is recommended for most patients ( for some patients radiation therapy may be offered up front ) with Eastern Cooperative Oncology Group performance status 0 or 1 and a favorable comorbidity profile .
There is no clear evidence to support one regimen over another .
PURPOSE To provide evidence -based recommendations to oncologists and others for treatment of patients with locally advanced , unresectable pancreatic cancer .
Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for locally advanced pancreatic cancer.
PURPOSE Fractionated radiotherapy and chemotherapy for locally advanced pancreatic cancer achieves only modest local control . This prospect i ve trial evaluated the efficacy of a single fraction of 25 Gy stereotactic body radiotherapy ( SBRT ) delivered between Cycle 1 and 2 of gemcitabine chemotherapy . METHODS AND MATERIAL S A total of 16 patients with locally advanced , nonmetastatic , pancreatic adenocarcinoma received  gemcitabine with SBRT delivered 2 weeks after completion of the first cycle . Gemcitabine was resumed 2 weeks after SBRT and was continued until progression or dose-limiting toxicity . The gross tumor volume , with a 2 - 3-mm margin , was treated in a single 25-Gy fraction by Cyberknife . Patients were evaluated at 4 - 6 weeks , 10 - 12 weeks , and every 3 months after SBRT . RESULTS All 16 patients completed SBRT . A median of four cycles ( range one to nine ) of chemotherapy was delivered . Three patients ( 19 % ) developed local disease progression at 14 , 16 , and 21 months after SBRT . The median survival was 11.4 months , with 50 % of patients alive at 1 year . Patients with normal  carbohydrate antigen (CA)19 - 9 levels either at diagnosis or after Cyberknife SBRT had longer survival ( p < 0.01 ) . Acute gastrointestinal toxicity was mild , with 2 cases of Grade 2 ( 13 % ) and 1 of Grade 3 ( 6 % ) toxicity . Late gastrointestinal toxicity was more common , with five ulcers ( Grade 2 ) , one duodenal stenosis ( Grade 3 ) , and one duodenal perforation ( Grade 4 ) . A trend toward increased duodenal volumes radiated was observed in those experiencing late effects ( p = 0.13 ) . CONCLUSION SBRT with gemcitabine result ed in comparable survival to conventional chemoradiotherapy and good local control . However , the rate of duodenal ulcer development was significant
Initial systemic chemotherapy ( 6 months ) with a combination regimen is recommended for most patients ( for some patients radiation therapy may be offered up front ) with Eastern Cooperative Oncology Group performance status 0 or 1 and a favorable comorbidity profile .
There is no clear evidence to support one regimen over another .
PURPOSE To provide evidence -based recommendations to oncologists and others for treatment of patients with locally advanced , unresectable pancreatic cancer .