Methods: Practitioner feedback was obtained through a mailed survey of 152 clinicians in Ontario (29 medical oncologists, 20 radiation oncologists and 103 surgeons). The survey consisted of items evaluating the methods, results and discussion used to inform the draft recommendations and whether the draft recommendations above should be approved as a practice guideline. Written comments were invited. Follow-up reminders were sent at two weeks (post card) and four […]
There were no randomized studies of chemotherapy and/or radiation compared with supportive care alone. Although studies of chemotherapy or immunotherapy for the treatment of metastatic pancreatic cancer enrolled patients with locally advanced disease, none reported the results of treatment separately for patients with locally advanced disease. Consequently, chemotherapy alone, radiotherapy alone and immunotherapy cannot be recommended routinely for patients with locally advanced disease.
Three randomized trials have shown chemoradiotherapy to be superior to either chemotherapy alone or radiation alone in terms of improved survival. Among three randomized trials of chemoradiotherapy comparing different chemotherapeutic agents, no chemotherapy regimen was superior to 5-FU in […]
In this poorly powered study, there were no statistically significant differences in survival or local control among the arms. Median disease-free survival was also similar among treatment groups: 3.7 months with neutron irradiation, 3.4 months with mixed radiation beams and 3.7 months with pure photon irradiation. However, three neutron-irradiated patients suffered moderate to life-threatening gastrointestinal toxicity compared with one patient treated with photons.
Chemoradiotherapy comparing different types of radiation beams: The Radiation Therapy Oncology Group randomized 49 evaluable patients to receive radiation treatment that was radiotherapeutically equivalent to 64 Gy of photon radiation treatment. Either pure photons or neutrons, or a combination (mixed-beam irradiation) of both, were used (Table 1[D]). Neutron irradiation was postulated to have several advantages due to its high linear energy transfer properties and, thus, the possibility of improved local […]
Chemoradiotherapy comparing different chemotherapeutic agents: Three randomized trials of chemoradiotherapy evaluated different chemotherapeutic agents (Table 1[C]). The Southwest Oncology Group randomly allocated 69 patients to 60 Gy of radiation with methyl lomustine 125 mg/m2 orally every six weeks and 5-FU 400 mg/m2 weekly, with or without testalactone 200 mg orally daily. Survival was similar in each arm (P=0.68). Among 62 evaluable patients, the most common adverse effects were myelosuppres-sion (87%) and […]
Chemoradiotherapy versus chemotherapy: There were two randomized trials of chemoradiotherapy compared with chemotherapy alone (Table 1[B]). A study by the Eastern Cooperative Oncology Group (ECOG) suggested that 5-FU alone was as effective as combined therapy with 5-FU and radiation. 5-FU was given at a dose of 600 mg/m2 weekly until disease progression. Chemoradiotherapy consisted of 5-FU 600 mg/m2 IV on the first three days of radiation, which was administered to […]
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