Induction Chemotherapy Followed by Concomitant Chemoradiation using Intensity Modulated Radiotherapy Technique in Locally Advanced Unresectable Pancreatic Cancer patients | ||
| Egyptian Journal of Cancer and Biomedical Research | ||
| Volume 7, Issue 2, June 2023, Pages 57-69 PDF (2.21 M) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/jcbr.2023.195990.1293 | ||
| Authors | ||
| Rana Ali Elfalah* 1; Fatma Zakaria Fatma Zakaria2; Nehal Elmashad2; Mohammad Hamdy3; Mohamed Mahmoud4 | ||
| 1٣٤ ش السلام من رياض غرابه خلف المقاولون العرب. طنطا الدور الثالث شقه ٥ الدو الثالث شقه ٥ | ||
| 2Department of Clinical Oncology & Nuclear Medicine, Faculty of Medicine, Tanta University, Egypt | ||
| 3Department of Gastrointestinal & Laparoscopic Surgery, Faculty of Medicine, Tanta University, Egypt | ||
| 4Department of Radiation Oncology, National Cancer Institute, Cairo University | ||
| Abstract | ||
| 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. | ||
| Keywords | ||
| Induction chemotherapy; concomitant chemoradiation; locally advanced pancreatic cancer; intensity modulated radiotherapy | ||
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