Concurrent Chemoradiation of Patients with Inoperable Non-Metastatic Pancreatic Cancer

Background: Inoperable non-metastatic pancreatic cancer is a great challenge because the median survival is generally less than 1 year and the impact of standard therapies is so limited. All patients should be considered for protocol-based therapy. The aim of this study is to determine the tolerability and efficacy of Gemcitabine concurrent with 3D conformal radiotherapy for locally advanced, unresectable, non-metastatic pancreatic cancer. Methods: Thirty three patients received the following protocol in 3 phases; induction phase: Weekly Gemcitabine at a dose of 1,000 mg/m2 over 30 minutes infusion for 7 weeks, chemoradiotherapy phase: Gemcitabine 600 mg/m2 weekly for 5 weeks concurrent with 3 dimensional (3D) conformal radiotherapy for a total dose of 50.4 Gy in 28 fractions in 5.5 weeks, 5 days per week, and maintenance phase: Gemcitabine at a dose of 1,000 mg/m2 weekly for 3 weeks with 1 week rest between 2 cycles. Results: Forty eight patients with locally advanced unresectable pancreatic cancer were enrolled; only 33 patients completed the treatment protocol. After a median follow-up period of 20 months 15 patients were alive. The median progression free survival (PFS) was 15 months; the median overall survival was 19 months. The estimated 12 months, 18 months and 24 months survival was 79%, 42%, and 18% respectively. Grade III toxicity were reported in 37.5% of patients with no grade VI toxicity, vomiting were the most common toxicity (32.5%) followed by fatigue (21.5%). Conclusions: Gemcitabine concurrent with 3D conformal radiotherapy is active, well tolerated and associated with encouraging survival in patients with locally advanced pancreatic cancer.