title: Helical tomotherapy with concurrent capecitabine for the treatment of inoperable pancreatic cancer.
abstract: BACKGROUND
  Helical tomotherapy, an advanced intensity-modulated radiation therapy with integrated CT imaging, permits highly conformal irradiation with sparing of normal tissue. Capecitabine, a pro-drug of 5-FU that induces thymidine phosphorylase can achieve higher levels of intracellular 5-FU when administered concurrently with radiation. We evaluated the feasibility as well as the clinical outcome of concurrent administration of capecitabine with tomotherapy in patients with advanced pancreatic cancer.
  
  
  METHODS
  Nineteen patients with advanced pancreatic cancer including primarily unresectable disease and recurrence after curative surgery were included in the study. Two planning target volumes (PTV) were entered: PTV1 is gross tumor volume; and PTV2, the volume of the draining lymph nodes. The total doses to target 1 and target 2 were 55 and 50 Gy, respectively. Capecitabine at 1600 mg/m2/day was administered on each day of irradiation.
  
  
  RESULTS
  Twenty six measurable lesions were evaluated. Overall in-field response rate was 42.3%; partial responses were achieved in 53.3% of the pancreatic masses, 28.6% of distant metastatic lesions and 25.0% of regional lymph nodes. The median duration of follow-up after tomotherapy was 6.5 months. None of the lesions showed in-field progression. Treatment was well tolerated with only minor toxicities such as grade 1 nausea (one patient), grade 1 hand-foot syndrome (one patient) and grade 1/2 fatigue (three patients).
  
  
  CONCLUSIONS
  Helical tomotherapy with concurrent capecitabine is a feasible option without significant toxicities in patients with advanced pancreatic cancer. We achieved excellent conformal distribution of radiation doses and minimal treatment-related toxicities with promising target volume responses.
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea, St Mary's Hospital, 62, Youidodong, Youngdeoungpogu, Seoul, 150-713, Republic of Korea.
authors.forename: Jeong-Seon
authors.initials: JS
authors.lastname: Ji
authors.forename: Chi-Wha
authors.initials: CW
authors.lastname: Han
authors.forename: Jeong-Won
authors.initials: JW
authors.lastname: Jang
authors.forename: Bo-In
authors.initials: BI
authors.lastname: Lee
authors.forename: Byung-Wook
authors.initials: BW
authors.lastname: Kim
authors.forename: Hwang
authors.initials: H
authors.lastname: Choi
authors.forename: Ji-Yoon
authors.initials: JY
authors.lastname: Kim
authors.forename: Young-Nam
authors.initials: YN
authors.lastname: Kang
authors.forename: Chul-Seung
authors.initials: CS
authors.lastname: Kay
authors.forename: Ihl-Bohng
authors.initials: IB
authors.lastname: Choi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D000069287:Capecitabine; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil