Toxicities and effects of involved-field irradiation with concurrent cisplatin for unresectable carcinoma of the pancreas.
OBJECTIVE
To evaluate local effects and acute toxicities of involved field irradiation with concurrent cisplatin (CDDP) for unresectable pancreatic carcinoma.


METHODS
Thirty-three patients with unresectable pancreatic carcinoma were treated with chemoradiotherapy. Sixteen were Stage IVA; 17 were Stage IVB. The total prescribed dose of radiotherapy was 50 Gy/25 fractions or 50.4 Gy/28 fractions, using a three-dimensionally determined involved-field that included only the primary tumor and clinically enlarged lymph nodes. Twelve patients received a daily i.v. infusion of CDDP; 21 patients received a combination of CDDP and 5-fluorouracil either i.v. or through the proper hepatic artery.


RESULTS
Twenty-seven (82%) patients completed planned chemoradiotherapy. Nausea was the most frequent complaint. No patient experienced Grade 4 toxicities. More than half achieved pain relief. As for the primary site, only 4 patients (12%) achieved a partial response at 4 weeks; however, 3 additional patients attained >50% tumor reduction thereafter. The most frequent site of disease progression was the liver, and only 3 patients developed local progression alone. No regional lymph nodal progression outside the treatment field was seen. Median survival time and survival at 1 year were 7.1 months and 27%, respectively, for the entire group. Difference in overall survival between patients with and without distant metastases was significant (p = 0.01).


CONCLUSIONS
Involved-field irradiation with concurrent daily CDDP was well tolerated without compromising locoregional effects.
Kawakami
Hiroyuki
H
Department of Radiology, Chiba University Graduate School of Medicine, Chuou-ku, Chiba-City, Chiba, Japan.
Uno
Takashi
T
Isobe
Kouichi
K
Ueno
Naoyuki
N
Aruga
Takashi
T
Sudo
Kentaro
K
Yamaguchi
Taketo
T
Saisho
Hiromitsu
H
Kawata
Tetsuya
T
Ito
Hisao
H
D015746:Abdominal Pain / Q000188:drug therapy; D000230:Adenocarcinoma / Q000188:drug therapy* / Q000532:radiotherapy* / Q000556:secondary; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001416:Back Pain / Q000188:drug therapy; D018395:CA-19-9 Antigen / Q000097:blood; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D017211:Treatment Failure
D018395:CA-19-9 Antigen; D002945:Cisplatin; D005472:Fluorouracil