The feasibility of dose escalation using concurrent radiation and 5-fluorouracil therapy following pancreaticoduodenectomy for pancreatic carcinoma

  • William F. Regine
  • William J. John
  • Patrick McGrath
  • William E. Strodel
  • Mohammed Mohiuddin
Original articles

DOI: 10.1007/s005340050154

Cite this article as:
Regine, W., John, W., McGrath, P. et al. J Hep Bil Pancr Surg (2000) 7: 53. doi:10.1007/s005340050154

Abstract:

We evaluated the feasibility of dose escalation using external beam radiation therapy (RT) and 5-fluorouracil (5-FU) following pancreaticoduodenectomy for pancreatic carcinoma. Fourteen patients who underwent pancreaticoduodenectomy for stage I–III adenocarcinoma of the pancreas received postoperative high-dose chemoradiation. RT was given at 1.8-Gy daily fractions to total doses of 54 Gy for patients with negative surgical margins (n = 12), and 64.8 Gy for those with gross residual disease (n = 2). Concurrent 5-FU was given as a continuous infusion (CI) at 225 mg/m2 per day (n = 9) beginning or day 1 and continuing until the completion of RT, or by bolus injection at 500 mg/m2 per day (n = 5) during weeks 1 and 4 of RT. Follow-up ranged from 32 to 36 months (median, 35 months). All patients were able to complete the planned high-dose postoperative chemoradiation and none required a treatment break. No grade 4 acute toxicity was observed. Grade 3 acute toxicity was limited to 2 patients. Two patients developed grade 3 (n = 1) or 4 (n = 1) subacute toxicity, all gastrointestinal-related. There have been no fatal toxicities and no grade 3 or 4 late toxicity has been observed. The 3-year survival is 21%. Dose escalation of postoperative 5-FU chemoradiation following pancreaticoduodenectomy for pancreatic carcinoma is well tolerated. Further dose-intensification of postoperative adjuvant therapy in these patients appears feasible and is being evaluated in a recently activated national trial.

Key words: pancreas cancer, radiation therapy, chemotherapy 

Copyright information

© Springer-Verlag Tokyo 2000

Authors and Affiliations

  • William F. Regine
    • 1
  • William J. John
    • 2
  • Patrick McGrath
    • 3
  • William E. Strodel
    • 3
  • Mohammed Mohiuddin
    • 1
  1. 1.Department of Radiation Medicine, University of Kentucky, 800 Rose St., Lexington KY 40536-0084, USAUS
  2. 2.Department of Internal Medicine, Division of Hematology/Oncology, University of Kentucky, Lexington KYUS
  3. 3.Department of General Surgery, Division of Surgical Oncology, University of Kentucky; and Veterans Administrative Medical Center, Lexington KYUS