Combined modality therapy for pancreatic cancer

Abstract

The purpose of this single center confirmatory study was to reveal the outcome achieved with three drug chemotherapy and split course external beam radiotherapy as a treatment for unresectable stage II and III pancreatic carcinoma. Concomitant 54 Gray split course radiation and fluorouracil on days 1-5, streptozocin on days 1-3, and CDDP on day 3 (RTFSP) were repeated every 28-days. Fifty-five consecutive patients were enrolled. Prospectively registered patients were followed for a minimum of 2 years in an intent to treat analysis. The median survival times for stage II and III patients were 22.3 and 11.9 months, and 2 and 3 year survival rates were 35.3% and 12.1%, and 13.6% and 9%, respectively (p=.049). Stage III patients younger than 65 years of age had a median survival of 15.2 months versus 6.4 months for older patients (p=.002). Downstaging of T3 tumors to T1-2 was confirmed in patients with high grade obstruction of vessels. Twenty-four downstaged patients sent for resection had a median survival of 33 months and 5 year survival of 33%. A multivariate analysis showed that stage (p=.002) and the interaction between stage and age (p=.01) predicted for survival; while tumor size, performance status, RT dose, gender, delayed RT, interrupted RT and toxicity did not. RT-FSP has produced more favorable palliation and survival compared with other treatment modalities for pancreatic cancer.