Study of Induction Chemotherapy Followed by Radiochemotherapy in Locally Advanced Pancreatic Cancer
Condition: Pancreatic Cancer
MeSH terms: Pancreatic Neoplasms
Study type: Interventional
Phase: Phase 2

Summary: 
      There is no a clear consensus regarding the optimal treatment of locally advanced pancreatic
      disease. There is a potential role for neoadjuvant therapy to treat micrometastatic disease
      with chemotherapy, as well as for the treatment of local disease with radiotherapy. The
      investigators evaluated the safety and efficacy of induction chemotherapy with oxaliplatin
      and gemcitabine followed by a high weekly dose of gemcitabine concurrent to radiation therapy
      in patients with borderline resectable and unresectable locally advanced pancreatic cancer
    

Detailed description: 
      Continued optimization in multimodality therapy and an accurate patient selection remain
      crucial points for the appropriate treatment of patients with pancreatic cancer.

      In all patients an accurate pre-treatment staging was performed, including: physical
      examination, complete blood tests and tumor markers, endoscopic ultrasonography (EUS) with
      fine needle aspiration biopsy, multilayer CT scan, PET-CT (positron emission computed
      tomography) with 18F-2-fluoro-2-deoxy-D-glucose (FDG) and laparoscopy with peritoneal
      washing. Jaundiced patients before or during treatment underwent endoscopic biliary stenting.

      Patients with the evidence of metastatic disease were excluded, and thus only a small number
      of patients was consequently enrolled with this neoadjuvant approach.

      The induction phase of the treatment plan was designed to administer gemcitabine 1000 mg/mq
      and oxaliplatin 100 mg/mq every 14 days for four doses.

      In the combined phase of the treatment all patients underwent simulation by using a Siemens
      16-CT simulator (Siemens Medical System). Radiotherapy target volumes were established by CT
      scan and PET-CT scan.

      Four weeks after the completion of radiochemotherapy, restaging, consisting of clinical
      examination, laboratory test, tumor markers, CT scan and PET-CT scan, was performed. Tumor
      response was defined in accordance with the World Health Organization (WHO) definition
      through CT scan and PET-CT scan. Surgery was considered in patients whose tumors were
      technically resectable.

      After resection, patients were evaluated every three months by means of a standard
      surveillance protocol that included history and physical examination, cross-sectional imaging
      and measurement of serum markers, and the intervals were extended to six months after two
      years
    

Intervention name(s): Radiation; Chemotherapy
Intervention type(s): Radiation; Drug
Intervention description(s): Radiotherapy target volumes are established by CT scan and PET-CT scan. Radiotherapy is delivered with a total dose of 54-59 Gy with fractionation of 1.8 Gy daily for 5 days a week. The Planning Target Volume (PTV) is defined by CTV with a safety margin of 1cm in all directions to include organ motion and set-up errors. Organs at risk for radiation-induced side effects are contoured on the dose planning CT and dose volume histograms (DVH) are calculated. All treatments are delivered with a 15-MV linear accelerator (Varian Medical System) with a multifield isocentric technique using a multileaf collimator. A quality-control protocol are applied for all patients with periodical digital portal images to evaluate the precision of the set-up.; The induction phase of the treatment plan is designed to administer gemcitabine 1000 mg/mq and oxaliplatin 100 mg/mq every 14 days for four doses. Chemotherapy concurrent to conformal radiation therapy is gemcitabine at the dose of 600 mg/mq weekly.
Other intervention name(s): Neoadjuvant therapy; Induction therapy
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: radiochemotherapy; neoadjuvant therapy