Locally advanced pancreatic cancer treated with radiation and 5-fluorouracil

A retrospective analysis was performed, in a single institution, of patients with locally advanced pancreatic carcinoma without evidence of distant metastases, who were treated with chemoradiation. Between 1994 and 2000, 24 patients were treated with radiation and 5-fluorouracil (5-FU). The standard dose of radiation prescribed was 45 Gy to the 95% isodose in 25 fractions over 5 weeks. 5-FU was given as a 60 min infusion on days 1-5 and 29-33 at 350 mg/m2, following low dose folinic acid. Actuarial survival, local control and toxicity rates were assessed for the group. The median survival was 12 months, with a 48% 1-year survival and a 29% 2-year survival. The median time to progression was 8 months. The treatment was well tolerated and all patients achieved 100% compliance. In terms of radiological tumour response, five patients (22%) had a complete response, 10 patients (45%) demonstrated partial tumour shrinkage and a further three additional patients had radiological stable disease. The majority of patients experienced a symptomatic improvement. Chemoradiation can produce effective local control with symptomatic improvement in patients with localised carcinoma of the pancreas. Further studies are needed to determine the most effective combination of chemotherapy agents, combined with radiotherapy in the management of this disease.