The treatment of locally advanced pancreatic cancer: RESULTS (Part 6)

In: Pancreatic cancer

21 Jul 2012

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.

Adverse effects of chemoradiotherapy: Chemoradiotherapy can be associated with cytopenia, nausea, vomiting and diarrhea (Table 2). However, these adverse effects are generally tolerable, and treatment-related deaths are unusual. Combination 5-FU and radiation is also well tolerated. Although not superior to 5-FU in efficacy, other chemotherapeutic regimens appear to be more toxic.

TABLE 2 Adverse effects of treatment

Reference Treatment Arm Nausea or vomiting (%) Adverse effects – all grades Diarrhea (%) Leucopenia (%) Thrombocytopenia (%) Treatment-related deaths
A) Chemoradiotherapy versus radiotherapy alone
Moertel et al, RTCT (5-FU) 76 13 100 52 NR
1969 RT alone 40 6 31 7 NR
GITSG 9273, RTCT (60 Gy + 5-FU) 86 7 78 37 NR*
1981 RTCT (40 Gy + 5-FU) 77 6 62 45 1
RT alone (60 Gy) 64 0 52 8 NR*
B) Chemoradiotherapy versus chemotherapy alone
ECOG, RTCT (5-FU) NR NR 17 NR NR
1985 CT (5-FU) NR NR 2P<0.05 NR NR
GITSG 9283, RTCT (5-FU+SMF) 78 46 100 100 NR
1988 CT (SMF) 95 48 100 100 NR
C) Chemoradiotherapy with comparison of different chemotherapy regimens
SWOG, RTCT (mCCNU+5-FU) Did not report adverse effects separated by treatment arm (%)
1980 RTCT (mCCNU+5-FU) CT (testalactone).
GITSG 9277, RTCT (5-FU) 36 0
1985 RTCT (doxorubicin) 53P<0.05 1
Earle et al, RTCT (5-FU) 90 0 50 NR 0
1994 RTCT (hycanthone) 90 2Grade 3+ 0<2000 mm3 NR 1
D) Comparison of different types of radiation beams
RTOG, Photons 9 0 0 NR
1989 Mixed 9 0 0 NR
Neutrons 6Grade 3+ 6Grade 3+ 0(all adverse hematological effects) NR

 *Two other patient deaths noted in report, treatment arm unspecified. 5-FU Bolus 5-fluorouracil; CT Chemotherapy; ECOG Eastern Cooperative Oncology Group; GITSG Gastrointestinal Tumor Study Group; Gy Gray; mCCNU Methyl lomustine; NR Not reported; RT Radiotherapy; RTCT Chemoradiotherapy; RTOG Radiation Therapy Oncology Group; SMF Streptozocin, mitomycin, 5-FU; SWOG Southwest Oncology Group

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