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 |
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Authors: | Koichi Taira Narikazu Boku Akira Fukutomi Yusuke Onozawa Shuichi Hironaka Takayuki Yoshino Hirofumi Yasui Kentaro Yamazaki Keisei Taku Takayuki Hashimoto Tetsuo Nishimura |
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Institution: | (1) Divison of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan;(2) Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan;(3) Present address: Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan |
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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. |
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Keywords: | locally advanced pancreatic cancer chemoradiation 5-fluorouracil gemcitabine |
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