Liver, Pancreas, and Biliary Tract

Journal of Gastroenterology

, Volume 43, Issue 11, pp 875-880

First online:

Results of a retrospective analysis of gemcitabine as a second-line treatment after chemoradiotherapy and maintenance chemotherapy using 5-fluorouracil in patients with locally advanced pancreatic cancer

  • Koichi TairaAffiliated withDivison of Gastrointestinal Oncology, Shizuoka Cancer Center
  • , Narikazu BokuAffiliated withDivison of Gastrointestinal Oncology, Shizuoka Cancer Center
  • , Akira FukutomiAffiliated withDivison of Gastrointestinal Oncology, Shizuoka Cancer Center
  • , Yusuke OnozawaAffiliated withDivison of Gastrointestinal Oncology, Shizuoka Cancer Center
  • , Shuichi HironakaAffiliated withDivison of Gastrointestinal Oncology, Shizuoka Cancer Center
  • , Takayuki YoshinoAffiliated withDivison of Gastrointestinal Oncology, Shizuoka Cancer Center
  • , Hirofumi YasuiAffiliated withDivison of Gastrointestinal Oncology, Shizuoka Cancer Center
  • , Kentaro YamazakiAffiliated withDivison of Gastrointestinal Oncology, Shizuoka Cancer Center
  • , Keisei TakuAffiliated withDivison of Gastrointestinal Oncology, Shizuoka Cancer Center
    • , Takayuki HashimotoAffiliated withDivision of Radiation Oncology, Shizuoka Cancer Center
    • , Tetsuo NishimuraAffiliated withDivision of Radiation Oncology, Shizuoka Cancer Center

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Abstract

Background

Many studies of concurrent chemoradiation therapy with 5-fluorouracil (5-FU) for locally advanced pancreatic cancer have been reported with a median survival time of approximately 10 months. Recently, gemcitabine (GEM) has been administered immediately after chemoradiation. The clinical outcome of chemoradiation therapy in conjunction with 5-FU and second-line chemotherapy with GEM after disease progression has not been clarified.

Methods

Patients with locally advanced pancreatic cancer were treated with concurrent radiation therapy (1.8 Gy/fraction; total dose, 50.4 Gy) with 5-FU (200 mg/m2 every day) until disease progression, followed by GEM (1000 mg/m2, days 1, 8, 15, and every 4 weeks) as second-line therapy.

Results

Of the 18 patients with locally advanced pancreatic cancer who received chemoradiation therapy with 5-FU, there were three partial responses, giving a response rate of 17%. The median time to progression was 170 days. The median survival time was 443 days. During chemoradiation therapy, the incidences of grade 3 or 4 anorexia, nausea, mucositis, and gastric ulcer were 33%, 22%, 17%, and 17%, respectively. Sixteen patients received second-line chemotherapy with GEM, of whom one patient had a partial response. The median time to progression from the initiation of GEM was 113 days, and median overall survival time was 231 days. Major toxicities were hematological toxicities: grade 3 or 4 leukopenia in 75% and anemia in 31%.

Conclusions

The treatment strategy with concurrent chemoradiation and maintenance chemotherapy with 5-FU followed by second-line chemotherapy with GEM may be an option for locally advanced pancreatic cancer.

Key words

locally advanced pancreatic cancer chemoradiation 5-fluorouracil gemcitabine