Chemotherapy followed by chemoradiotherapy for locally advanced non-metastatic pancreatic cancer - a new paradigm?
Sir d We read with interest the paper published in the February 2010 issue of Clinical Oncology by the Velindre group of their experience of induction chemotherapy followed by chemoradiation in locally advanced nonmetastatic pancreatic cancer [1]. We have recently audited our results at the Beatson West of Scotland Cancer Centre for locally advanced non-metastatic pancreatic cancer deemed inoperable. Gemcitabine 1000 mg/m2 on days 1, 8 and 15 of a 4-week cycle as induction treatment and chemoradiotherapy to those with non-progression on chemotherapy after four cycles. Patients with a performance status of 0e2 were selected. All patients had conformal computed tomography planned radiotherapy with a multi-field technique to a dose of 4500 cGy in 25 fractions with either continuous 5-fluorouracil at a dose of 200e300 mg/m2 or weekly gemcitabine at a dose of 300 mg/m2 until the completion of radiotherapy. All patients completed treatment. The median age was 65 years (range 49e78). The median overall survival was 15.5 months (range 2 months e upper confidence interval not calculable as patients were still alive) and the time to progression taken from the end of radiotherapy to either the first clinical or radiological evidence of progression was 5.04 months (range 1e10 months). Treatment was well tolerated. Only two of the 19 reported grade 3 nausea or fatigue. Seventeen of 19 had either grade 1 or 2 nausea and fatigue as the most significant symptoms. Despite single-agent gemcitabine as induction treatment and a 4500 cGy radiotherapy dose concomitant with continuous infusion 5-fluorouracil, our results correlate well with the Velindre group, with a median survival of about 15 months. This compares favourably with quoted survivals of around 10e12 months by both the Velindre group and Huguet et al. [2] for patients continuing with chemotherapy alone.