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Is the therapeutic index better with gemcitabine-based chemoradiation than with 5-fluorouracil-based chemoradiation in locally advanced pancreatic cancer?

Publication ,  Journal Article
Crane, CH; Abbruzzese, JL; Evans, DB; Wolff, RA; Ballo, MT; Delclos, M; Milas, L; Mason, K; Charnsangavej, C; Pisters, PWT; Lee, JE; Lenzi, R ...
Published in: Int J Radiat Oncol Biol Phys
April 1, 2002

PURPOSE: To retrospectively compare the toxicity and efficacy of concurrent gemcitabine-based chemoradiation with that of concurrent 5-fluorouracil (5-FU)-based chemoradiation in patients with unresectable pancreatic cancer. PATIENTS AND METHODS: Between September 1996 and May 2000, 114 patients with localized unresectable adenocarcinoma of the pancreas were treated with concurrent chemoradiation. Locally advanced unresectable disease was defined as low-density tumor in contact with the superior mesenteric artery (SMA) or celiac artery, or occlusion of the superior mesenteric-portal venous confluence. Fifty-three patients were selected to receive gemcitabine in 7 weekly cycles (250-500 mg/m(2)) with concurrent radiotherapy (median dose 30 Gy, range 30-33 Gy in 10-11 fractions). The remaining 61 patients received continuous-infusion 5-FU (200-300 mg/m(2)) with concurrent radiotherapy (30 Gy in 10 fractions). Radiotherapy was delivered to the primary tumor and regional lymphatics. Patients receiving gemcitabine and those receiving 5-FU had a similar mean Karnofsky performance status (KPS, 89% vs. 86%), distribution of tumor grade (43% vs. 33% poorly differentiated), and percent weight loss (all p = NS). However, patients treated with gemcitabine had a significantly larger median maximum cross-sectional tumor area (TA, 8.8 cm(2) vs. 5.7 cm(2), p = 0.046) and were significantly younger (median age 60 vs. 68 years, p <0.001). Severe acute toxicity (ST) was defined as toxicity requiring a hospital stay of more than 5 days, mucosal ulceration with bleeding, more than 3 dose deletions of gemcitabine or discontinuation of 5-FU, or toxicity resulting in surgical intervention or death. Kaplan-Meier analysis was used to calculate the actuarial rate of local progression on imaging (LP), the rate of distant metastasis (DM), and the overall survival (OS) rate. The imaging was reviewed in resected patients. RESULTS: Patients receiving gemcitabine developed significantly more ST during treatment (23% vs. 2%, p < 0.0001) than did those receiving 5-FU. Patients treated with gemcitabine had a similar 10-month LP rate (62% vs. 61%), 10-month DM rate (55% vs. 47%), 1-year OS rate (42% vs. 28%), and median OS duration (11 months vs. 9 months) to patients treated with 5 FU (all p = NS). Five patients who received gemcitabine and 1 patient who received 5-FU underwent margin-negative pancreaticoduodenectomy after chemoradiation. Three patients had a short segment (

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Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

April 1, 2002

Volume

52

Issue

5

Start / End Page

1293 / 1302

Location

United States

Related Subject Headings

  • Survival Analysis
  • Retrospective Studies
  • Radiation-Sensitizing Agents
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Humans
  • Gemcitabine
 

Citation

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Crane, C. H., Abbruzzese, J. L., Evans, D. B., Wolff, R. A., Ballo, M. T., Delclos, M., … Janjan, N. A. (2002). Is the therapeutic index better with gemcitabine-based chemoradiation than with 5-fluorouracil-based chemoradiation in locally advanced pancreatic cancer? Int J Radiat Oncol Biol Phys, 52(5), 1293–1302. https://doi.org/10.1016/s0360-3016(01)02740-7
Crane, Christopher H., James L. Abbruzzese, Douglas B. Evans, Robert A. Wolff, Mathew T. Ballo, Marc Delclos, Luka Milas, et al. “Is the therapeutic index better with gemcitabine-based chemoradiation than with 5-fluorouracil-based chemoradiation in locally advanced pancreatic cancer?Int J Radiat Oncol Biol Phys 52, no. 5 (April 1, 2002): 1293–1302. https://doi.org/10.1016/s0360-3016(01)02740-7.
Crane CH, Abbruzzese JL, Evans DB, Wolff RA, Ballo MT, Delclos M, et al. Is the therapeutic index better with gemcitabine-based chemoradiation than with 5-fluorouracil-based chemoradiation in locally advanced pancreatic cancer? Int J Radiat Oncol Biol Phys. 2002 Apr 1;52(5):1293–302.
Crane, Christopher H., et al. “Is the therapeutic index better with gemcitabine-based chemoradiation than with 5-fluorouracil-based chemoradiation in locally advanced pancreatic cancer?Int J Radiat Oncol Biol Phys, vol. 52, no. 5, Apr. 2002, pp. 1293–302. Pubmed, doi:10.1016/s0360-3016(01)02740-7.
Crane CH, Abbruzzese JL, Evans DB, Wolff RA, Ballo MT, Delclos M, Milas L, Mason K, Charnsangavej C, Pisters PWT, Lee JE, Lenzi R, Vauthey JN, Wong ABS, Phan T, Nguyen Q, Janjan NA. Is the therapeutic index better with gemcitabine-based chemoradiation than with 5-fluorouracil-based chemoradiation in locally advanced pancreatic cancer? Int J Radiat Oncol Biol Phys. 2002 Apr 1;52(5):1293–1302.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

April 1, 2002

Volume

52

Issue

5

Start / End Page

1293 / 1302

Location

United States

Related Subject Headings

  • Survival Analysis
  • Retrospective Studies
  • Radiation-Sensitizing Agents
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Humans
  • Gemcitabine