Accelerated radiochemotherapy in pancreatic cancer is not necessarily related to a pathologic pancreatic function decline in the early period.
OBJECTIVE
To evaluate the functional effects of ionizing radiation in patients with unresectable pancreatic cancer in the early period after accelerated radiochemotherapy (ART).


METHODS
To analyze the exocrine component, the amino acid consumption test and fecal elastase 1 were performed in 13 patients immediately before and 4-8 weeks after ART. Pancreatic duct morphology was evaluated before therapy. Weight loss and clinical steatorrhea were recorded. Endocrine parameters were examined according to standardized criteria.


RESULTS
The relative change of the amino acid consumption test results and the median elastase concentration was 41.2% and 56.4%, respectively. Five patients still had normal test results after ART and 5 patients developed pathologic values. The median relative weight loss of the total body weight was 7.7% +/- 4.5%. No steatorrhea occurred. Of the 5 patients with normal values, 3 had a mean organ dose of <40 Gy. Of the 5 patients with pathologic values, 4 had a mean organ dose of >41 Gy. The endocrine function measurements remained unchanged.


CONCLUSIONS
Although a nominal reduction of exocrine function parameters occurred in most patients, ART was not necessarily related to a pathologic level in the early period. Diabetes was not established. The functional impairment that was existent in the patient population presumably contributed to the weight loss. Pancreatic enzyme preparations may also play a role in maintaining an anabolic state during and after radiochemotherapy.
Horst
Eckehard
E
Department of Radiation Oncology, University of Münster, Münster, Germany. horste@uni-muenster.de
Seidel
Matthias
M
Micke
Oliver
O
Rübe
Christian
C
Glashörster
Marco
M
Schäfer
Ulrich
U
Willich
Normann A
NA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000596:Amino Acids / Q000008:administration & dosage / Q000378:metabolism; D015415:Biomarkers / Q000032:analysis; D001786:Blood Glucose / Q000032:analysis; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005243:Feces / Q000201:enzymology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000503:physiopathology / Q000528:radiation effects*; D010183:Pancreatic Ducts / Q000503:physiopathology / Q000528:radiation effects; D010196:Pancreatic Elastase / Q000032:analysis; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy*; D011446:Prospective Studies; D014176:Protein Biosynthesis
D000596:Amino Acids; D015415:Biomarkers; D001786:Blood Glucose; D010196:Pancreatic Elastase