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 .
Placebo controlled trial of enteric coated pancreatin microsphere treatment in patients with unresectable cancer of the pancreatic head region
Background —Impeded flow of pancreatic juice due to mechanical obstruction of the pancreatic duct in patients with cancer of the pancreatic head region causes exocrine pancreatic insufficiency with steatorrhoea and creatorrhoea . This may contribute to the profound weight loss that often occurs in these patients . Aims —To investigate whether pancreatic enzyme replacement therapy prevents this weight loss . Patients —Twenty one patients with unresectable cancer of the pancreatic head region with suspected pancreatic duct obstruction , a biliary endoprosthesis in situ , and a Karnofsky performance status greater than 60 . Methods —R and omised double blind trial of eight weeks with either placebo or high dose enteric coated pancreatin enzyme supplementation . All patients received dietary counselling . Results —The mean difference in the percentage change of body weight was 4.9 % ( p=0.02 , 95 % confidence interval for the difference : 0.9 to 8.9 ) . Patients on pancreatic enzymes gained 1.2 % ( 0.7 kg ) body weight whereas patients on placebo lost 3.7 % ( 2.2 kg ) . The fat absorption coefficient in patients on pancreatic enzymes improved by 12 % whereas in placebo patients it dropped by 8 % ( p=0.13 , 95 % confidence interval for the difference : –6 to 45 ) . The daily total energy intake was 8.42 MJ in patients on pancreatic enzymes and 6.66 MJ in placebo patients ( p=0.04 , 95 % confidence interval for the difference : 0.08 to 3.44 ) . Conclusions —Weight loss in patients with unresectable cancer of the pancreatic head region and occlusion of the pancreatic duct can be prevented , at least for the period immediately after insertion of a biliary endoprosthesis , by high dose enteric coated pancreatin enzyme supplementation in combination with dietary counselling
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 .