title: Chemotherapy followed by chemoradiotherapy in locally advanced pancreatic cancer: A literature review and report of two cases.
abstract: The optimal treatment of patients with locally advanced pancreatic cancer remains to be elucidated. Chemo-radiotherapy is regarded as the treatment of choice, and studies have examined the sequential schedule of induction chemoradiotherapy followed by chemoradiotherapy, with favourable results. This study investigated the principal clinical trials of chemoradiotherapy treatment in locally advanced pancreatic cancer in 2 patients. The 2 patients received induction chemotherapy with gemcitabine 1000 mg/mq day on days 1 and 8 of a 21-day cycle for two cycles, followed by chemoradiotherapy with concurrent radiosensitizer bi-weekly gemcitabine 50 mg/mq for six weeks. Radiotherapy consisted of an external conformational 3D treatment administered to the pancreatic bed and locoregional nodes, with a total dose of 4500 Gy fractionated in 180 Gy/day, and a boost of 900 Gy to the neoplastic mass. Efficacy was evaluated four weeks after the end of treatment by a computed tomography (CT) scan and by fluorodeoxyglucose positron-emission tomography/CT. The patients underwent further treatment with periodical instrumental evaluation. A disease control rate was observed in the two patients following sequential treatment, enhanced by subsequent treatment. The two patients remained alive 23-24 months following the diagnosis. The sequential treatment schedule therefore was an effective option in our locally advanced pancreatic cancer patients. A phase III trial and further investigation are required to verify this option in clinical practice.
authors.affiliation: 'L and A Seràgnoli' Department of Hematology and Oncological Sciences, University of Bologna, 40138 Bologna, Italy.
authors.forename: Mariacristina
authors.initials: M
authors.lastname: DI Marco
authors.forename: Marina
authors.initials: M
authors.lastname: Macchini
authors.forename: Silvia
authors.initials: S
authors.lastname: Vecchiarelli
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casadei
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pezzilli
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
authors.forename: Lucia
authors.initials: L
authors.lastname: Zanoni
authors.forename: Lucia
authors.initials: L
authors.lastname: Calculli
authors.forename: Enza
authors.initials: E
authors.lastname: Barbieri
authors.forename: Donatella
authors.initials: D
authors.lastname: Santini
authors.forename: Roberto
authors.initials: R
authors.lastname: DI Cicilia
authors.forename: Giovanni
authors.initials: G
authors.lastname: Brandi
authors.forename: Guido
authors.initials: G
authors.lastname: Biasco