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Medline ® Abstract for Reference 45

of 'Initial chemotherapy and radiation for nonmetastatic, locally advanced, unresectable and borderline resectable, exocrine pancreatic cancer'

Capecitabine and radiation therapy preceded and followed by combination chemotherapy in advanced pancreatic cancer.
Schneider BJ, Ben-Josef E, McGinn CJ, Chang AE, Colletti LM, Normolle DP, Hejna GF, Lawrence TS, Zalupski MM
Int J Radiat Oncol Biol Phys. 2005;63(5):1325. Epub 2005 Jul 1.
PURPOSE: The primary objective of this study was to evaluate the tolerance and toxicity of radiation therapy (RT) and capecitabine in patients with advanced, unresectable pancreatic carcinoma. To control micrometastatic disease, combination chemotherapy (gemcitabine and cisplatin) before and after combined modality therapy (CMT) was planned.
METHODS AND MATERIALS: Patients with unresectable or metastatic pancreatic cancer were eligible. Gemcitabine 1000 mg/m2 and cisplatin 35 mg/m2 were administered on Days 1 and 8 of a 21-day cycle for two cycles. RT was then given to a dose of 50.4 Gy in 1.8 Gy fractions. Patients were treated with capecitabine 1330 mg/m2 daily during RT. After CMT, two additional cycles of gemcitabine and cisplatin completed the treatment.
RESULTS: Twenty-three patients were treated. Eighteen patients completed CMT. One patient was removed from study during CMT for toxicity issues. Treatment delays and dose reductions were common during the final two cycles of gemcitabineand cisplatin as a result of myelosuppression. Median survival was 10.1 months (95% confidence interval [CI]= 7.6, 13.7) for all 23 patients and 12.8 months (95% CI = 8.2, 18.9) for 18 patients without metastasis.
CONCLUSION: Combined modality therapy with RT and capecitabine was well tolerated. Chemotherapy after CMT was difficult to complete owing to cumulative myelosuppression. Survival, response, and toxicity were comparable to infusional 5-fluorouracil and RT.
Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA.