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• W2076603524 abstract "Gemcitabine has become the mainstay of chemotherapy in the treatment of pancreatic cancer. Whether concurrent chemoradiotherapy is detrimental or provides any benefit over treatment with gemcitabine alone in the treatment of locally advanced pancreatic cancer is controversial. The aim of this study is to determine whether concurrent chemoradiation compromises the ability to deliver sequential chemotherapy in clinical practice. Pharmacy and medical records of 42 consecutive patients treated with conformal 3-D radiation and concurrent gemcitabine for locally advanced pancreatic cancer were examined. Gemcitabine was given intravenously at 1000 mg/m2 weekly during radiation, and continued weekly at 1000 mg/m2 following radiation for 3 weeks on, one week off until disease progression. A subset of six patients had received 3 or more weekly cycles of gemcitabine prior to radiation therapy (mean of 8.5 cycles, range 3-17) The gross tumor volume (GTV) was defined as the primary tumor identifiable on CT scan, including enlarged nodes greater than 1 cm. Clinically uninvolved regional lymph node basins were not included. The clinical target volume (CTV) was the GTV plus 0.5 cm, or the tumor bed and was extended by an additional 0.5 cm for the PTV. Radiation dose was either 15 fractions of 2.4 Gy or 25 fractions of 1.8Gy. During radiotherapy, 34 patients (79%) received weekly gemcitabine as prescribed and 8 patients received fewer cycles. Following radiation, 22 patients (51.1%) continued to receive sequential chemotherapy for at least 3 cycles (mean of 9.5 cycles range 3-36). The median absolute dose of gemcitabine was 1749 mg/ cycle for patients receiving chemotherapy prior to chemo-radiation vs. 1990 mg/cycle for patients who received subsequent chemotherapy following chemo-radiation (p = ns). The median survival was 12.4 months. Grade III-IV gastrointestinal toxicity was observed in 6 patients (17.6%) with 2 patients requiring surgery for small bowel obstruction. One patient developed grade III thrombocytopenia after 15 cycles of gemcitabine. The delivery of sequential weekly gemcitabine until disease progression, following reduced volume conformal chemo-radiation, is feasible and tolerable. The median survival in this cohort was comparable or superior to that reported in contemporary studies. Concurrent conformal chemo-radiation is a valid treatment option and does not compromise the tolerability of subsequent sequential chemotherapy." @default.
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• W2076603524 date "2009-11-01" @default.
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• W2076603524 title "Does Concurrent Chemoradiotherapy Compromise the Delivery of Subsequent Sequential Gemcitabine in Locally Advanced Pancreatic Cancer?" @default.
• W2076603524 doi "https://doi.org/10.1016/j.ijrobp.2009.07.665" @default.
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