[Three-dimensional conformal radiation therapy concurrent with full dose Gemcitabine for locally advanced inoperable
Sefi Mendlovic1, Zvi Symon, Yulia Kundel
1Faculty of Medicine, Ben Gurion University, Beer Sheba.
Background:
Gemcitabine is a potent radiosensitizer of pancreatic cancer cells. Concomitant full dose Gemcitabine and three dimensional conformal radiation to a small field is a novel approach to unresectable locally advanced pancreatic cancer. The aim of this study is to report the outcome, tolerability and toxicity of this combined therapy.
Methods:
A retrospective chart review, with survival data confirmed by the population registry and statistic analysis was performed with SPSS. Radiotherapy was planned using computerized tomography, treated only the gross tumor without regional lymph nodes and was delivered in 15 fractions of 2.4 Gy to a dose of 36 Gy. Gemcitabine was administered weekly during radiation at a dose of 1000 mg/m2. Gastrointestinal toxicity was scored according to the NCI Common Toxicity Criteria. Local control was assessed by RECIST criteria, a partial response defined as a decrease of at least 30% in the longest diameter of the tumor.
Results:
Eighteen of the 19 patients completed treatment as planned without the need for treatment break. Four patients subsequently developed severe grade III-IV gastrointestinal toxicity; 37% of patients achieved a partial response and 52% experienced significant clinical benefit. The median survival was 11.7 months.
Discussion:
Full dose gemcitabine with conformal 3-D radiotherapy to a small field was well tolerated and was associated with a low incidence of severe gastrointestinal toxicity compared with previous studies of combination therapy using standard large radiation portals which encompass both the tumor and the regional lymph nodes. A partial response was observed in over one third of patients, non-progression of the irradiated tumor in the rest with pain relief and clinical benefit in more than half the patients.
Conclusion:
This treatment approach was well tolerated with little morbidity and achieves outcomes equal to or better than other contemporary combination modality approaches.
