Healthcare Professionals
Chemoradiotherapy
Although no head to head comparisons have been made, but some studies have shown that chemoradiation approaches are better as compared to radiation or chemotherapy alone. In a study published in 1969 with patients with different types of GI cancers, 64 patients who had locally unresectable pancreatic cancer were treated with either placebo or 5-FU combined with 35 to 40Gy radiation. It was found that the survival rate was higher in the chemoradiation arm.16 In another study, 194 patients with locally advanced pancreatic cancer were given either EBRT alone or with 5-FU, 500mg/m2 on the first 3 days of each 20Gy radiation. The overall survival was better in the combined modality arm.17 Another study compared chemotherapy alone with chemoradiation. Chemotherapy included treatment with SMF (Streptozotocin, Mitomycin and 5-FU) and chemoradiation included SMF with EBRT. The chemoradiation arm showed a significant improvement in median survival.18
Chemoradiation with gemcitabine is now being considered with more interest because it is not only beneficial in the metastatic setting but also because gemcitabine has potent radiosensitising properties. It has been used in varying dosages from 300 mg/m2 to 700 mg/m2 or 1000 mg/m2 weekly x 3 every four weeks for additional cycles of radiotherapy. It was found that the maximum tolerated dose of gemcitabine was dependent upon the radiation therapy field size.
A study of database of 114 patients with locally advanced pancreatic cancer was carried out at M. D. Anderson Cancer Center (MDACC) to compare 5-FU and gemcitabine in combination with radiation therapy.19 A significantly higher incidence of severe acute toxicity developed in patients receiving gemcitabine compared with those receiving 5-FU. Out of the 53 patients treated with gemcitabine/radiation therapy, 5 subsequently underwent surgical resection compared to 1 of 61 patients treated with 5-FU/radiation therapy. Median survival was similar in short median follow-up.
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