title: Efficacy and tolerability of limited field radiotherapy with concurrent capecitabine in locally advanced pancreatic cancer.
abstract: OBJECTIVE
  Patients with locally advanced pancreatic cancer (LAPC) are most commonly managed with chemotherapy or concurrent chemoradiotherapy (CRT), which may or may not include non-involved regional lymph nodes in the clinical target volume. We present our results of CRT for LAPC using capecitabine and delivering radiotherapy to a limited radiation field that excluded non-involved regional lymph nodes from the clinical target volume.
  
  
  METHODS
  Thirty patients were studied. Patients received 50.4 Gy external beam radiotherapy in 28 fractions, delivered to a planning target volume expanded from the primary tumour and involved nodes only. Capecitabine (500-600 mg/m2) was given twice daily continuously during radiotherapy. Toxicity and efficacy data were prospectively collected.
  
  
  RESULTS
  Nausea, vomiting and tumour pain were the most common grade 2 toxicities. One patient developed grade 3 nausea. The median time to progression was 8.8 months, with 20% remaining progression free at 1 year. The median overall survival was 9.7 months with a 1 year survival of 30%. Of 21 patients with imaged progression, 13 (62%) progressed systemically, three (14%) had local progression, two (10%) had locoregional progression and three (14%) progressed with both local/locoregional and systemic disease.
  
  
  CONCLUSIONS
  CRT using capecitabine and limited field radiotherapy is a well-tolerated, relatively efficacious treatment for LAPC. The low toxicity and low regional progression rates support the use of limited field radiotherapy, allowing evaluation of this regimen with other anti-cancer agents.
authors.affiliation: Academic Radiation Oncology, The University of Manchester, Department of Medical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK. Andrewjackson3@nhs.net
authors.forename: A S N
authors.initials: AS
authors.lastname: Jackson
authors.forename: P
authors.initials: P
authors.lastname: Jain
authors.forename: G R
authors.initials: GR
authors.lastname: Watkins
authors.forename: G A
authors.initials: GA
authors.lastname: Whitfield
authors.forename: M M
authors.initials: MM
authors.lastname: Green
authors.forename: J
authors.initials: J
authors.lastname: Valle
authors.forename: M B
authors.initials: MB
authors.lastname: Taylor
authors.forename: C
authors.initials: C
authors.lastname: Dickinson
authors.forename: P M
authors.initials: PM
authors.lastname: Price
authors.forename: A
authors.initials: A
authors.lastname: Saleem
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; 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; D018450:Disease Progression; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D011355:Prodrugs / Q000627:therapeutic use*; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D011355:Prodrugs; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil