Concomitant chemoradiotherapy with low-dose weekly gemcitabine for nonmetastatic unresectable pancreatic cancer

Beste Melek ATASOY, Faysal DANE, Aysegul UCUNCU KEFELI, Hale CAGLAR, Asim CINGI, Nazim Serdar TURHAL, Ufuk ABACIOGLU, Cumhur YEGEN
2011 The Turkish Journal of Gastroenterology  
Amaç: Bu çal›flmada kemoradyoterapiyle tedavi edilen rezeke edilemeyen ve metastatik olmayan pankreas kanserinde radyosensitizan amaçl› düflük doz gemsitabininin, etkinli¤i ve tolerabilitesi araflt›r›ld›. Yöntem: Histolojik olarak tan› konmufl 24 pankreas kanseri hastas› (kad›n/erkek: 10/14; ortanca yafl 60) de¤erlendirildi. Yedi (%29) hastada gemsitabin, tek bafl›na ya da di¤er ajanlarla birlikte indüksiyon amaçl› kullan›lm›flt›. Efl zamanl› gemsitabin 75 mg/m 2 olarak haftal›k uyguland›. Üç
more » ... l›k uyguland›. Üç boyutlu konformal radyoterapi ile primer tümöre ve pozitif lenfatiklere 4500 cGy verildi. Lokal progresyonsuz sa¤kal›m, uzak metastazs›z sa¤kal›m ve tüm sa¤kal›m Kaplan-Meier metodu ile hesapland›. Bulgular: Ortanca takip 36 hafta idi. Ortanca lokal progresyonsuz sa¤kal›m, uzak metastazs›z sa¤kal›m ve tüm sa¤kal›m s›ras›yla 22 hafta (%95 GA 5-59 hafta), 19 hafta (9%5 GA 6.9-31 hafta) ve 36 hafta (%95 GA 28-43 hafta) idi. Bütün hastalar radyoterapiyi planland›¤› dozda tamamlad›. Efl zamanl› gemsitabin tam olarak %58.3 hastaya uyguland›. Gemsitabin dört (%16.6) hastada derece 3 nötropeni (n=1), derece 3 bulant›/kusma (n=2) ve hastan›n reddi (n=1) nedeniyle kesildi. Kemoradyoterapi sonras› lokal tümörü cevap veren ya da stabil kalan hastalarda ortanca sa¤kal›m 39 hafta (%95 GA 30-47.9 hafta) iken progresyon gösterenlerde 36 hafta (%95 GA 9.7-62.2 hafta) idi (p=0.52). Hastalar›n %50'sinde a¤r› palyasyonu sa¤land›. Sonuç: Rezeke edilemeyen pankreas kanserinde radyosensitizan haftal›k düflük doz gemsitabin etkili ve güvenlidir. Anahtar kelimeler: Kemoradyoterapi, gemsitabin, düflük doz, pankreas kanseri, rezeke edilemeyen Background/aims: This study aimed to demonstrate the efficacy and tolerability of low-dose weekly gemcitabine as a radiosensitizer in unresectable pancreatic cancer patients treated with chemoradiotherapy. Methods: Twenty-four histologically confirmed pancreatic carcinoma patients (female/male: 10/14, median age: 60) were evaluated. Seven (29%) patients received gemcitabine either as a single agent or in combination prior to chemoradiotherapy. Concurrent 75 mg/m 2 gemcitabine was infused weekly. Radiotherapy was delivered to the primary tumor and positive lymphatics with 3D-conformal radiotherapy to a total dose of 4500 cGy. Local progression-free survival, distant metastasis-free survival and overall survival were evaluated by Kaplan-Meier method. Results: Median follow-up was 36 weeks. Median local progression-free survival, distant metastasis-free survival and overall survival were 22 weeks (95% confidence interval [CI]: 5-59 weeks), 19 weeks (95%CI: 6.9-31 weeks) and 36 weeks (95%CI: 28-43 weeks), respectively. All patients completed radiotherapy as scheduled. Concurrent gemcitabine was given fully in 58.3% of patients. Gemcitabine was terminated in four (16.6%) patients due to grade 3 neutropenia (n=1), grade 3 nausea/vomiting (n=2) or patient's reluctance (n=1). Patients with local response and stable disease to chemoradiotherapy revealed a median survival of 39 weeks (95%CI: 30-47.9 weeks) compared to 36 weeks (95%CI: 9.7-62.2 weeks) in patients with locally progressive disease (p=0.52). Pain was improved in 50% of patients. Conclusions: Weekly low-dose radiosensitizing gemcitabine is effective and safe in unresectable pancreatic cancer patients.
doi:10.4318/tjg.2011.0158 pmid:21480113 fatcat:vvbrtpbjwze5dpextdtfhlb76m