Adjuvant Chemo-Radiotherapy versus Chemotherapy in Pancreatic Carcinoma

Abstract

Background: Pancreatic carcinoma has the worst prognosis of all gastrointestinal solid tumors. Only 15-20% of cases present at a resectable stage and the rate of local recurrence is high.Aim: To assess tolerability and efficacy of adjuvant chemo-radiotherapy (CRT) for pancreatic carcinoma compared to chemotherapy (CTH) alone.Methods: This was a prospective study with historical control group. The intervention group involved patients who underwent a 3-phases protocol following Whipple surgery. In the first phase, weekly gemcitabine was administered at a dose of 1 gm/m2 for 3 weeks. The second was a CRT phase whereas capecitabine (800 mg/m2) used twice daily for 5-6 weeks concurrent with 3 dimensional conformal radiotherapy. Finally, the maintenance phase in which gemcitabine administered at a dose of 1 gm/m2 weekly for 3 weeks with 1 week rest for 3 cycles. The historical group included patients who received gemcitabine only within the preceding 2 years.Results: From 50 patients with pancreatic cancer in the intervention group, 41 completed the treatment protocol versus 40 patients in the control group. The estimated median disease-free survival was 15 months in the CRT group versus 10 months in the CTH group, and the estimated mean was 19.4 versus 13.2 (p = 0.041). The estimated median overall survival was not reached in both treatment arms. The estimated mean overall survival was 27.9 months in the CRT group compared to 19.2 months in the CTH group (p = 0.023). The relapse rate was 29% in the CRT group versus 65% in the CTH group (p= 0.001). CRT was associated with more toxicity which was tolerated with no interruption of treatment. Conclusions: Adjuvant gemcitabine before and after capecitabine concurrent with 3D conformal radiotherapy was tolerated with better survival and local control in pancreatic cancer patients.