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The feasibility of dose escalation using concurrent radiation and 5‐fluorouracil therapy following pancreaticoduodenectomy for pancreatic carcinoma
Author(s) -
Regine William F.,
John William J.,
McGrath Patrick,
Strodel William E.,
Mohiuddin Mohammed
Publication year - 2000
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s005340050154
Subject(s) - medicine , pancreaticoduodenectomy , radiation therapy , toxicity , fluorouracil , adenocarcinoma , pancreatectomy , bolus (digestion) , carcinoma , surgery , gastroenterology , acute toxicity , regimen , pancreas , stage (stratigraphy) , chemotherapy , cancer , paleontology , biology
Abstract We evaluated the feasibility of dose escalation using external beam radiation therapy (RT) and 5‐fluorouracil (5‐FU) following pancreaticoduodenectomy for pancreatic carcinoma. Fourteen patients who underwent pancreaticoduodenectomy for stage I—III adenocarcinoma of the pancreas received postoperative high‐dose chemoradiation. RT was given at 1.8‐Gy daily fractions to total doses of 54 Gy for patients with negative surgical margins ( n = 12), and 64.8 Gy for those with gross residual disease ( n = 2). Concurrent 5‐FU was given as a continuous infusion (CI) at 225 mg/m 2 per day ( n = 9) beginning or day 1 and continuing until the completion of RT, or by bolus injection at 500 mg/m 2 per day ( n = 5) during weeks 1 and 4 of RT. Follow‐up ranged from 32 to 36 months (median, 35 months). All patients were able to complete the planned high‐dose postoperative chemoradiation and none required a treatment break. No grade 4 acute toxicity was observed. Grade 3 acute toxicity was limited to 2 patients. Two patients developed grade 3 ( n = 1) or 4 ( n = 1) subacute toxicity, all gastrointestinal‐related. There have been no fatal toxicities and no grade 3 or 4 late toxicity has been observed. The 3‐year survival is 21%. Dose escalation of postoperative 5‐FU chemoradiation following pancreaticoduodenectomy for pancreatic carcinoma is well tolerated. Further dose‐intensification of postoperative adjuvant therapy in these patients appears feasible and is being evaluated in a recently activated national trial.