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 .
Phase-II study on stereotactic radiotherapy of locally advanced pancreatic carcinoma.
BACKGROUND AND PURPOSE The majority of patients with pancreatic cancer have advanced disease at the time of diagnosis and are not amenable for surgery . Stereotactic radiotherapy ( SRT ) may be an alternative treatment for patients with locally advanced disease . The effect of SRT was investigated in the present phase-II trial . PATIENTS AND METHODS Twenty-two patients with locally advanced and surgically non-resectable , histological proven pancreatic carcinoma were included into the trial . The patients were immobilized by the Elekta stereotactic body frame ( SBF ) or a custom made body frame . SRT was given on st and ard LINAC with st and ard multi-leaf collimator . Central dose was 15 Gyx3 within 5 - 10 days . RESULTS Evaluation of response was found to be very difficult due to radiation and tumour related tissue reaction . Only two patients ( 9 % ) were found to have a partial response ( PR ) , the remaining had no change ( NC ) or progression ( PD ) after treatment . Six patients had local tumour progression , but only one patient had an isolated local failure without simultaneous distant metastasis . Median time to local or distant progression was 4.8 months . Median survival time was 5.7 months and only 5 % were alive 1 year after treatment . Acute toxicity reported 14 days after treatment was pronounced . There was a significant deterioration of performance status ( P=0.008 ) , more nausea ( P=0.001 ) and more pain ( P=0.008 ) after 14 days compared with base-line . However , 8 of 12 patients ( 66 % ) improved in performance status , scored less nausea , pain , or needed less analgesic drugs at 3 months after treatment . Four patients suffered from severe mucositis or ulceration of the stomach or duodenum and one of the patients had a non-fatal ulcer perforation of the stomach . CONCLUSIONS SRT was associated with poor outcome , unacceptable toxicity and question able palliative effect and can not be recommended for patients with advanced pancreatic carcinoma
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 .