Chemoradiation for ductal pancreatic carcinoma: Principles of combining chemotherapy with radiation, definition of target volume and radiation dose

Journal of the Pancreas

Volumn 6, Issue 3, 2005, Pages 216-230

  Wilkowski, Ralf ^a   Thoma, Martin ^a   Weingandt, Helmut ^a   Dühmke, Eckhart ^a   Heinemann, Volker ^a  

^a LUDWIG MAXIMILIANS UNIVERSITY   (Germany)

Author keywords

Antineoplastic combined chemotherapy protocols; Combined modality therapy; Drug therapy; Pancreatic neoplasms; Radiotherapy

Indexed keywords

AMIFOSTINE; ANTINEOPLASTIC AGENT; CISPLATIN; CYCLOPHOSPHAMIDE; DOCETAXEL; DOXORUBICIN; FLUOROURACIL; GEMCITABINE; IRINOTECAN; METHOTREXATE; MITOMYCIN C; OXALIPLATIN; PACLITAXEL; STREPTOZOCIN; TOPOTECAN; VINCRISTINE;

ADVANCED CANCER; ANEMIA; CANCER COMBINATION CHEMOTHERAPY; CANCER LOCALIZATION; CANCER RADIOTHERAPY; CANCER RECURRENCE; CANCER SURVIVAL; CLINICAL PROTOCOL; CLINICAL TRIAL; DEHYDRATION; DIARRHEA; DRUG DOSE REGIMEN; DRUG EFFICACY; DRUG TOLERABILITY; FISTULA; GASTRODUODENAL ULCER; GASTROINTESTINAL DISEASE; GASTROINTESTINAL HEMORRHAGE; HUMAN; INTENSITY MODULATED RADIATION THERAPY; LEUKOPENIA; LUNG TOXICITY; LYMPHATIC DRAINAGE; METASTASIS; MONOTHERAPY; MULTIMODALITY CANCER THERAPY; NAUSEA; NEUTROPENIA; PANCREAS CARCINOMA; PANCREAS RESECTION; PNEUMONIA; RADIATION DOSE; REVIEW; THROMBOCYTOPENIA; TREATMENT PLANNING; VOMITING;

ANTIMETABOLITES, ANTINEOPLASTIC; CARCINOMA, PANCREATIC DUCTAL; CLINICAL TRIALS; COMBINED MODALITY THERAPY; DEOXYCYTIDINE; DOSE-RESPONSE RELATIONSHIP, RADIATION; FLUOROURACIL; HUMANS; PANCREAS; PANCREATIC NEOPLASMS; RADIATION TOLERANCE; RADIOTHERAPY DOSAGE; RADIOTHERAPY, COMPUTER-ASSISTED; RADIOTHERAPY, CONFORMAL;

EID: 27644505137     PISSN: 15908577     EISSN: 15908577     Source Type: Journal    
DOI: None     Document Type: Review

References (67)

1. Brunner TB, Grabenbauer GG, Baum U, Hohenberger W, Sauer R. Adjuvant and neoadjuvant radiochemotherapy in ductal pancreatic carcinoma. Strahlenther Onkol 2000; 176:265-73.
2. Wiegel T, Runkel N, Frommhold H, Rube C, Hinkelbein W, et al. Radiotherapeutic strategies in the multimodal therapy of resectable and nonresectable pancreatic carcinoma. Strahlenther Onkol. 2000; 176:299-306.
3. Kelly DM, Benjamin IS. Pancreatic carcinoma. Ann Oncol 1995; 6:19-28.
4. Ishikawa O, Ohigashi H, Imaoka S, Sasaki Y, Iwanaga T, Matayoshi Y, Inoue T. Is the long-term survival rate improved by preoperative irradiation prior to Whipple's procedure for adenocarcinoma of the pancreatic head? Arch Surg 1994; 129:1075-80.
5. Jessup JM, Steele G Jr, Mayer RJ, Posner M, Busse P, Cady B, et al. Neoadjuvant therapy for unresectable pancreatic adenocarcinoma. Arch Surg 1993; 128:559-64.
6. Wilkowski R, Thoma M, Heinemann V, Rau HG, Wagner A, Stoffregen C, et al. Radiochemotherapy with gemcitabine and cisplatin in pancreatic cancer-feasible and effective. Strahlenther Onkol 2003; 179:78-86.
7. Krzyzanowska MK, Weeks JC, Earle CC. Treatment of locally advanced pancreatic cancer in the real world: population-based practices and effectiveness. J Clin Oncol 2003; 21:3409-14.
8. Bruckner HW, Kalnicki S, Dalton J, Schwartz GK, Chesser MR, Mandeli J, Janus C. Combined modality therapy increasing local control of pancreatic cancer. Cancer Invest 1993; 11:241-6. [PMID 8485645]
9. Cullinan S, Moertel CG, Wieand HS, Schutt AJ, Krook JE, Foley JF, et al. A phase III trial on the therapy of advanced pancreatic carcinoma. Evaluations of the Mallinson regimen and combined 5-fluorouracil, doxorubicin, and cisplatin Cancer 1990; 65:2207-12. [PMID 2189551]
10. Kamthan AG, Morris JC, Dalton J, Mandeli JP, Chesser MR, Leben D, et al. Combined modality therapy for stage II and stage III pancreatic carcinoma. J Clin Oncol 1997; 15:2920-7. [PMID 9256136]
11. Burris HA 3rd, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, et al. Improvements in survival and clinical benefit with gemcitabine as firstline therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 1997; 15:2403-13. [PMID 9196156]
12. Heinemann V, Wilke H, Mergenthaler HG, Clemens M, Konig H, Illiger HJ, et al. Gemcitabine and cisplatin in the treatment of advanced or metastatic pancreatic cancer. Ann Oncol 2000; 11:1399-1403. [PMID 11142479]
13. Lawrence TS, Chang EY, Hahn TM, Hertel LW, Shewach DS. Radiosensitization of pancreatic cancer cells by 2',2'-difluoro-2'-deoxycytidine. Int J Radiat Oncol Biol Phys 1996; 34:867-72. [PMID 8598364]
14. Mose S, Karapetian M, Juling-Pohlit L, Taborski B, Ramm U, Damrau M, et al. The intensification of the radiotherapeutic effect on HeLa cells by gemcitabine. Strahlenther Onkol 1999; 175:78-83. [PMID 10065143]
15. Dobelbower RR Jr. The radiotherapy of pancreatic cancer. Semin Oncol 1979; 6:378-89. [PMID 116365]
16. Moertel CG, Childs DS Jr, Reitemeier RJ, Colby MY Jr, Holbrook MA. Combined 5-fluorouracil and supervoltage radiation therapy of locally unresectable gastrointestinal cancer. Lancet 1969; 2:865-7. [PMID 4186452]
17. Sindelar WF, Kinsella TJ. Studies of intraoperative radiotherapy in carcinoma of the pancreas. Ann Oncol 1999; 10 Suppl 4:226-30. [PMID 10436828]
18. Zerbi A, Fossati V, Parolini D, Carlucci M, Balzano G, Bordogna G, et al. Intraoperative radiation therapy adjuvant to resection in the treatment of pancreatic cancer. Cancer 1994; 73:2930-5.
19. Coquard R, Ayzac L, Gilly FN, Romestaing P, Ardiet JM, Sondaz C, et al. Intraoperative radiotherapy in resected pancreatic cancer: feasibility and results. Radiother Oncol 1997; 44:271-5.
20. Roldan GE, Gunderson LL, Nagorney DM, Martin JK, Ilstrup DM, Holbrook MA, et al. External beam versus intraoperative and external beam irradiation for locally advanced pancreatic cancer. Cancer 1988; 61:1110-16. [PMID 3342371]
21. Shibamoto Y, Manabe T, Baba N, Sasai K, Takahashi M, Tobe T, Abe M. High dose, external beam and intraoperative radiotherapy in the treatment of resectable and unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 1990; 19:605-11. [PMID 2211209]
22. Furuse J, Kinoshita T, Kawashima M, Ishii H, Nagase M, Konishi M, et al. Intraoperative and conformal external-beam radiation therapy with protracted 5-fluorouracil infusion in patients with locally advanced pancreatic carcinoma. Cancer 2003; 97:1346-52. [PMID 12599244]
23. Gunderson LL, Martin JK, Kvols LK, Nagorney DM, Fieck JM, Wieand HS, et al. Intraoperative and external beam irradiation +/- 5-FU for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 1987; 13:319-29. [PMID 3104244]
24. Willich N, Teichmann R, Krimmel K, Naujokat B, Denecke H, Wendt T, et al. Intraoperative electron irradiation of malignant pancreatic tumors--initial experiences at Grosshadern. Strahlenther Onkol 1988; 164:187-94. [PMID 2452490]
25. Hall EJ. Time, dose and fractionation in radiotherapy. Radiobiology for the radiologist. Fourth edition, 219-21. Philadelphia: J.B.Lippincott Company, 1994.]
26. Moertel CG, Frytak S, Hahn RG, O'Connell MJ, Reitemeier RJ, Rubin J, et al. Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil: The Gastrointestinal Tumor Study Group. Cancer 1981; 48:1705-10. [PMID 7284971]
27. Gastrointestinal Tumor Study Group. Treatment of locally unresectable carcinoma of the pancreas: comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone. J Natl Cancer Inst 1988; 80:751-5. [PMID 2898536]
28. Klaassen DJ, MacIntyre JM, Catton GE, Engstrom PF, Moertel CG. Treatment of locally unresectable cancer of the stomach and pancreas: a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil--an Eastern Cooperative Oncology Group study. J Clin Oncol 1985; 3:373-8. [PMID 3973648]
29. Klinkenbijl JH, Jeekel J, Sahmoud T, van Pel R, Couvreur ML, Veenhof CH, et al. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 1999; 230:776-84. [PMID 10615932]
30. Neoptolemos JP, Dunn JA, Stocken DD, Almond J, Link K, Beger H, et al. Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet 2001; 358:1576-85. [PMID 11716884]
31. Blackstock AW, Bernard SA, Richards F, Eagle KS, Case LD, Poole ME, et al. Phase I trial of twice-weekly gemcitabine and concurrent radiation in patients with advanced pancreatic cancer. J Clin Oncol 1999; 17:2208-12. [PMID 10561277]
32. Kudrimoti M, Regine W, John W, Hanna N, Mohiuddin M. Concurrent Infusional Gemcitabine and Radiation in the Treatment of Advanced Unresectable GI Malignancy: A Phase I/II Study. Proc Am Soc Clin Oncol 1999; 18:A 928.]
33. de Lange SM, van Groeningen CJ, Meijer OW, Cuesta MA, Langendijk JA, van Riel JM, et al. Gemcitabine-radiotherapy in patients with locally advanced pancreatic cancer. Eur J Cancer 2002; 38:1212-7. [PMID 12044508]
34. Crane CH, Abbruzzese JL, Evans DB, Wolff RA, Ballo MT, Delclos M, et al. Is the therapeutic index better with gemcitabine-based chemoradiation than with 5-fluorouracil-based chemoradiation in locally advanced pancreatic cancer? Int J Radiat Oncol Biol Phys 2002; 52:1293-302. [PMID 11955742]
35. Ashamalla H, Zaki B, Mokhtar B, Colella F, Selim H, Krishnamurthy M, Ross P. Hyperfractionated radiotherapy and paclitaxel for locally advanced/unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 2003; 55:679-87. [PMID 12573755]
36. McGinn CJ, Zalupski MM. Radiation therapy with once-weekly gemcitabine in pancreatic cancer: Current status of clinical trials. Int J Radiat Oncol Biol Phys 2003; 56:10-15.
37. Hoffman JP, McGinn CJ, Szarka C, Morphis J, Cooper HS, Wilkes J, et al. A phase I study of preoperative gemcitabine with radiation therapy followed by postoperative gemcitabine for patients with localized, resectable pancreatic adenocarcinoma. Proc Am Soc Clin Oncol 1998; 17:A283.]
38. Wolff RA, Evans DB, Gravel DM, Lenzi R, Pisters PW, Lee JE, et al. Phase I trial of gemcitabine combined with radiation for the treatment of locally advanced pancreatic adenocarcinoma. Proc Am Soc Clin Oncol 1998; 17:A1091.]
39. Scalliet P, Goor C, Galdermans D, Meerbeek J, Groen HJ, van de Leest A, et al. GEMZAR[trade] (Gemcitabine) with thoracic radiotherapy - a phase II pilot study in chemonaive patients with advanced nonsmall cell lung cancer (NSCLC). Proc Am Soc Clin Oncol 1998; 17:A1923 ]
40. Groen H, Gregor A, van Putten J, van der Leest A, Little F, Jungnelius U, et al. Phase I Study of Gemcitabine (G) and High-Dose Thoracic Radiation (RT) in Stage III Non-Small Lung Cancer (NSCLC). Proc Am Soc Clin Oncol 2000; 19:A2123 ]
41. Vokes EE, Herndon JE 2nd, Crawford J, Leopold KA, Perry MC, Miller AA, Green MR. Randomized phase II study of cisplatin with gemcitabine or paclitaxel or vinorelbine as induction chemotherapy followed by concomitant chemoradiotherapy for stage IIIB non-small-cell lung cancer: cancer and leukemia group B study 9431 J Clin Oncol 2002; 20:4191-8. [PMID 12377962]
42. Tepper JE, Noyes D, Krall JM, Sause WT, Wolkov HB, Dobelbower RR, et al: Intraoperative radiation therapy of pancreatic carcinoma: A report of RTOG-8505. Int J Radiat Oncol Biol Phys 1991; 21:1145-9. [PMID 1657839]
43. McGinn CJ, Zalupski MM, Shureiqi I, Robertson JM, Eckhauser FE, Smith DC, et al. Phase I trial of radiation dose escalation with concurrent weekly fulldose gemcitabine in patients with advanced pancreatic cancer. J Clin Oncol 2001; 19:4202-8.
44. Kayahara M, Nagakawa T, Ohta T, Kitagawa H, Ueno K, Tajima H, et al. Analysis of paraaortic lymph node involvement in pancreatic carcinoma: a significant indication for surgery? Cancer 1999; 85:583-90 [PMID 10091731]
45. Kayahara M, Nagakawa T, Futagami F, Kitagawa H, Ohta T, Miyazaki I. Lymphatic flow and neural plexus invasion associated with carcinoma of the body and tail of the pancreas. Cancer 1996; 78:2485-91. [PMID 8952555]
46. Kayahara M, Nagakawa T, Ueno K, Ohta T, Tsukioka Y, Miyazaki I. Surgical strategy for carcinoma of the pancreas head area based on clinicopathologic analysis of nodal involvement and plexus invasion. Surgery 1995; 117:616-23. [PMID 7778025]
47. Manabe T, Baba N, Nonaka A, Asano N, Yamaki K, Shibamoto Y, et al. Combined treatment using radiotherapy for carcinoma of the pancreas involving the adjacent vessels. Int Surg 1988; 73:153-6.
48. Bussels B, Goethals L, Feron M, Bielen D, Dymarkowski S, Suetens P, Haustermans K. Respiration-induced movement of the upper abdominal organs: a pitfall for the three-dimensional conformal radiation treatment of pancreatic cancer. Radiother Oncol 2003; 68:69-74.
49. Horst E, Micke O, Moustakis C, Schuck A, Schafer U, Willich NA. Conformal therapy for pancreatic cancer: variation of organ position due to gastrointestinal distention--implications for treatment planning. Radiology 2002; 222:681-6.
50. Emami B, Lyman J, Brown A, Coia L, Goitein M, Murizenrider JE, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991; 21:109-22.
51. McGinn CJ, Ten Haken RK, Ensminger WD, Walker S, Wang S, Lawrence TS. Treatment of intrahepatic cancers with radiation doses based on a normal tissue complication probability model. J Clin Oncol 1998; 16:2246-52.
52. Dawson LA, Ten Haken RK, Lawrence TS. Partial irradiation of the liver. Semin Radiat Oncol 2001; 11:240-6.
53. Willett CG, Tepper JE, Orlow EL, Shipley WU. Renal complications secondary to radiation treatment of upper abdominal malignancies. Int J Radiat Oncol Biol Phys 1986; 12:1601-4.
54. Phillips TL, Fu KK. Quantification of combined radiation therapy and chemotherapy effects on critical normal tissues. Cancer 1976; 37:1186-1200.
55. Landry JC, Yang GY, Ting JY, Staley CA, Torres W, Esiashvili N, Davis LW. Treatment of pancreatic cancer tumors with intensity-modulated radiation therapy (IMRT) using the volume at risk approach (VARA): employing dose-volume histogram (DVH) and normal tissue complication probability (NTCP) to evaluate small bowel toxicity. Med Dosim 2002; 27:121-9.
56. Crane CH, Antolak JA, Rosen II, Forster KM, Evans DB, Janjan NA, et al. Phase I study of concomitant gemcitabine and IMRT for patients with unresectable adenocarcinoma of the pancreatic head. Int J Gastrointest Cancer 2001; 30:123-32.
57. Gastrointestinal Tumor Study Group. Radiation therapy combined with Adriamycin or 5-fluorouracil for the treatment of locally unresectable pancreatic carcinoma. Cancer 1985; 56:2563-8.
58. McGinn CJ, Smith DC, Szarka CE, Pinover WH, Loehrer PJ, Morphis JG, et al. A phase I study of Gemcitabine in combination with radiation therapy in patients with localized, unresectable pancreatic cancer. Proc Am Soc Clin Oncol 1998; 17:A1014.
59. Epelbaum R, Rosenblatt E, Nasrallah S, Muler E, Yardeni T, Faraggi D, et al. A Phase II Study of Gemcitabine (GEM) Combined with Radiation Therapy (RT) in Patients with Localized, Unresectable Pancreatic Cancer. Proc Am Soc Clin Oncol 2000; 19:A1029.
60. Reyes-Vidal J, Rodriguez P, Reyes J, Buckel E, Veit O, Orlandi L, et al. Chemoradiation Therapy with Gemcitabine (GEM) in Advanced Pancreatic Cancer (APC). Proc Am Soc Clin Oncol 2000; 19:A1183.
61. Wilkowski R, Heinemann V, Rau HG. Radiochemotherapy Including Gemcitabine and 5-Fluorouracil for Treatment of Locally Advanced Pancreatic Cancer. Proc Am Soc Clin Oncol 2000; 19:A1078.
62. Talamonti MS, Catalano PJ, Vaughn DJ, Whittington R, Beauchamp RD, Berlin J, Benson AB 3rd. Eastern Cooperative Oncology Group Phase I trial of protracted venous infusion fluorouracil plus weekly gemcitabine with concurrent radiation therapy in patients with locally advanced pancreas cancer: a regimen with unexpected early toxicity. J Clin Oncol 2000; 18:3384-9. [PMID 11013279]
63. Kornek GV, Potter R, Selzer E, Schratter A, Ulrich-Pur H, Rogy M, et al. Combined radiochemotherapy of locally advanced unresectable pancreatic adenocarcinoma with mitomycin C plus 24-hour continuous infusional gemcitabine. Int J Radiat Oncol Biol Phys 2001; 49:665- 71. [PMID 11172947]
64. Yavuz AA, Aydin F, Yavuz MN, Ilis E, Ozdemir F. Radiation therapy and concurrent fixed dose amifostine with escalating doses of twice-weekly gemcitabine in advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2001; 51:974-81.
65. Safran H, Dipetrillo T, Iannitti D, Quirk D, Akerman P, Cruff D, et al. Gemcitabine, paclitaxel, and radiation for locally advanced pancreatic cancer: a Phase I trial. Int J Radiat Oncol Biol Phys 2002; 54:137-41.
66. Brunner TB, Grabenbauer GG, Klein P, Baum U, Papadopoulos T, Bautz W, et al. Phase I trial of strictly time-scheduled gemcitabine and cisplatin with concurrent radiotherapy in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2003; 55:144-53.
67. Li CP, Chao Y, Chi KH, Chan WK, Teng HC, Lee RC, et al. Concurrent chemoradiotherapy treatment of locally advanced pancreatic cancer: gemcitabine versus 5-fluorouracil, a randomized controlled study. Int J Radiat Oncol Biol Phys 2003 57:98-104.