Background: induction gemcitabine based chemotherapy followed by concomitant chemoradiation would increase response rate and resectability in locally advanced unresectable pancreatic cancer.
Patients: Patients with locally advanced unresectable pancreatic adenocarcinoma
Methods: were assigned to receive gemcitabine based chemotherapy for 2-4 cycles, patients who showed partial response were assigned to receive CCRT with IMRT technique, our primary endpoint was surgical resection, secondary end point was disease progression or unacceptable toxicity.
Results: After 2-4 cycles of induction chemotherapy. Only 28 patients received the planned protocol of chemoradiation. Nine patients underwent surgical resection. No marginal involvement (R0) was observed in 3 patients. They reached a complete response until the end of the study. Nineteen patients received chemoradiation only. Good partial response was observed in 13 patients, one showed stationary disease. Disease progression occurred in seven patients. Chemotherapy toxicity was mild in all patients. Neutropenia was more with Gemcitabine/ oxaloplatin. Thrombocytopenia was more in both gemciatabine monotherapy and gemcitabine / cisplatin arm. Anemia was more common with gemcitabine/cisplatin. Non heametological toxicity included, fatigue, Weight loss, gastrointestinal toxicity, nausea & vomiting. Radiation side effects were mild in all patients and included mild inflammatory skin reaction, delayed gastric emptying, flatulence or diarrhea. Gastrointestinal bleeding was observed in 5 patients. Progression free and overall survival rates were better in patients who received CCRT even who did not proceed for surgery.
Conclusion: the use of concomitant chemoradiation as part of a neoadjuvant multi-modality treatment is associated with improved outcomes, tumor downstaging, increased rate of R0 resection and better survival.