Clinical Research
Copyright ©The Author(s) 2003. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 15, 2003; 9(11): 2561-2564
Published online Nov 15, 2003. doi: 10.3748/wjg.v9.i11.2561
Intensity modulated radiation therapy and chemotherapy for locally advanced pancreatic cancer: Results of feasibility study
Yong-Rui Bai, Guo-Hua Wu, Wei-Jian Guo, Xu-Dong Wu, Yuan Yao, Yin Chen, Ren-Hua Zhou, Dong-Qin Lu
Yong-Rui Bai, Guo-Hua Wu, Xu-Dong Wu, Yuan Yao, Yin Chen, Ren-Hua Zhou, Dong-Qin Lu, Department of Radiation Oncology, Xinhua Hospital of Shanghai Second Medical University, Shanghai 200092, China
Wei-Jian Guo, Department of Oncology, Xinhua Hospital of Shanghai Second Medical University, Shanghai 200092, China
Author contributions: All authors contributed equally to the work.
Supported by Health Bureau of Shanghai City, No. 00436
Correspondence to: Dr. Yong-Rui Bai, Department of Radiation Oncology, Xinhua Hospital of Shanghai Second Medical University, Shanghai 200092, China. baiyongrui@online.sh.cn
Telephone: +86-21-65790000 Fax: +86-21-65030840
Received: June 16, 2003
Revised: July 14, 2003
Accepted: July 24, 2003
Published online: November 15, 2003
Abstract

AIM: To explore whether intensity modulated radiation therapy (IMRT) in combination with chemotherapy could increase radiation dose to gross tumor volume without severe acute radiation related toxicity by decreasing the dose to the surrounding normal tissue in patients with locally advanced pancreatic cancer.

METHODS: Twenty-one patients with locally advanced pancreatic cancer were evaluated in this clinical trial. Patients would receive the dose of IMRT from 21 Gy to 30 Gy in 7 to 10 fractions within two weeks after conventional radiotherapy of 30 Gy in 15 fractions over 3 wk. The total escalation tumor dose would be 51, 54, 57, 60 Gy, respectively. 5-fluororacil (5-FU) or gemcitabine was given concurrently with radiotherapy during the treatment course.

RESULTS: Sixteen patients who had completed the radiotherapy plan with doses of 51 Gy (3 cases), 54 Gy (3 cases), 57 Gy (3 cases) and 60 Gy (7 cases) were included for evaluation. The median levels of CA19-9 prior to and after radiotherapy were 716 U/mL and 255 U/mL respectively (P < 0.001) in 13 patients who demonstrated high levels of CA19-9 before radiotherapy. Fourteen patients who suffered from pain could reduce at least 1/3-1/2 amount of analgesic intake and 5 among these patients got complete relief of pain. Ten patients improved in Karnofsky performance status (KPS). The median follow-up period was 8 mo and one-year survival rate was 35%. No patient suffered more than grade III acute toxicities induced by radiotherapy.

CONCLUSION: Sixty Gy in 25 fractions over 5 wk with late course IMRT technique combined with concurrent 5-FU chemotherapy can provide a definitely palliative benefit with tolerable acute radiation related toxicity for patients with advanced pancreatic cancer.

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