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Multimodality therapy of localized unresectable pancreatic adenocarcinoma
Author(s) -
Whittington Richard,
Solin Lawrence,
Mohiuddin Mohammed,
Cantor Ronald I.,
Rosato Francis E.,
Biermann William A.,
Weiss Stephen M.,
Pajak Thomas F.
Publication year - 1984
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19841101)54:9<1991::aid-cncr2820540934>3.0.co;2-4
Subject(s) - medicine , regimen , radiation therapy , chemotherapy , surgery , external beam radiotherapy , adjuvant , brachytherapy , pancreas , oncology
Eighty‐eight patients with localized unresectable carcinoma of the pancreas were treated at Thomas Jefferson University Hospital between 1974 and 1981. Four treatment regimens were used which were sequential modifications of the technique based on the experience in the preceeding group of patients. Each treatment changed the course of the disease, and as patterns of failure were identified, the treatment was altered to deal with them. Initially, all patients were treated with external beam radiation. Subsequently, Iodine‐125 implantation was added to improve local control; low‐dose preoperative radiotherapy to reduce the risk of peritoneal seeding; and adjuvant chemotherapy to reduce the risks of distant metastases. The addition of 125 I implantation increased the local control from 22% to 81%, but did not increase the median survival, which was unchanged from 7 months. The addition of adjuvant chemotherapy increased the median survival from 7 months to 14 months, but had no impact on the control of the pancreatic tumor. Adjunctive chemotherapy and low‐dose preoperative radiotherapy appear synergistic in reducing the risk of peritoneal seeding. The combination of 125 I implantation, external beam radiation, and adjunctive chemotherapy is safe and effective. This regimen produces excellent local control with acceptable morbidity. This regimen produced a 30% survival at 18 months. The patterns of failure among these patients suggest future modifications of the technique.