Chemoradiotherapy with or without Induction Chemotherapy for Locally Advanced Pancreatic Cancer: a UK Multi-institutional Experience

Aims: The optimal management for patients with unresectable locally advanced adenocarcinoma of the pancreas (LAPC) is unclear. The aim of this study was to determine the outcome of patients treated with chemoradiotherapy (CRT) with or without induction chemotherapy. Materials and methods: We conducted a multi-centre retrospective analysis of 48 patients with biopsy-proven LAPC treated with CRT in four regional oncology centres in the UK between March 2000 and October 2007. The prescribed radiotherapy dose was 4500-5040 cGy in 25-28 fractions and was given concurrent with gemcitabine (n = 37), gemcitabine/cisplatin (n = 9), 5-fluorouracil (n = 1) or capecitabine (n = 1). Results: Four patients (8.3%) did not complete the intended treatment due to CRT-related toxicities. The disease control rate (Objective response rate (ORR) and stable disease (SD)) was 81.3%. The median overall survival was 17 months (range 5-66 months). In subgroup analysis, a trend towards improved survival was seen in patients who completed the intended treatment (17.1 months vs 11.0 months, P = 0.06) and in patients undergoing surgery (27 months vs 16 months, P = 0.023). Conclusions: This is the largest reported series from the UK focussing on patients who received CRT for pancreas cancer. It shows that it is possible to deliver pancreatic CRT with acceptable toxicity. Induction chemotherapy followed by gemcitabine-based CRT shows promising activity and should be evaluated in phase III studies. (C) 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.