Phase I study of neoadjuvant accelerated short course radiation therapy with photons and capecitabine for resectable pancreatic cancer.

Abstract

PURPOSE:

In this phase I study, we sought to determine the feasibility and tolerability of neoadjuvant short course radiotherapy (SC-CRT) delivered with photon RT with concurrent capecitabine for resectable pancreatic adenocarcinoma.

MATERIALS AND METHODS:

Ten patients with localized, resectable pancreatic adenocarcinoma were enrolled from December 2009 to August 2011. In dose level I, patients received 3 Gy × 10. In dose level 2, patients received 5 Gy × 5 (every other day). In dose level 3, patients received 5 Gy × 5 (consecutive days). Capecitabine was given during weeks 1 and 2. Surgery was performed 1-3 weeks after completion of chemotherapy.

RESULTS:

With an intended accrual of 12 patients, the study was closed early due to unexpected intraoperative complications. Compared to the companion phase I proton study, patients treated with photons had increased intraoperative RT fibrosis reported by surgeons (27% vs. 63%). Among those undergoing a Whipple resection, increased RT fibrosis translated to an increased mean OR time of 69 min. Dosimetric comparison revealed significantly increased low dose exposure to organs at risk for patients treated with photon RT.

CONCLUSIONS:

This phase I experience evaluating the tolerability of neoadjuvant SC-CRT with photon RT closed early due to unexpected intraoperative complications.

• Authors: Jennifer Y Wo, Harvey J Mamon, Cristina R Ferrone, David P Ryan, Lawrence S Blaszkowsky, Eunice L Kwak, Yolanda D Tseng, Brian N Napolitano, Marek Ancukiewicz, Richard S Swanson, Keith D Lillemoe, Carlos Fernandez-del Castillo, Theodore S Hong
• Journal: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology (Radiother Oncol) Vol. 110 Issue 1 Pg. 160-4 (Jan 2014) ISSN: 1879-0887 [Electronic] Ireland
• PMID: 24231241 (Publication Type: Clinical Trial, Phase I, Journal Article)
• Copyright: Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Antimetabolites, Antineoplastic
• Deoxycytidine
• Capecitabine
• Fluorouracil

Topics

• Adenocarcinoma (drug therapy, radiotherapy, surgery)
• Aged
• Antimetabolites, Antineoplastic (therapeutic use)
• Capecitabine
• Chemoradiotherapy
• Deoxycytidine (analogs & derivatives, therapeutic use)
• Dose-Response Relationship, Radiation
• Female
• Fluorouracil (analogs & derivatives, therapeutic use)
• Humans
• Intraoperative Complications (etiology)
• Male
• Middle Aged
• Neoadjuvant Therapy
• Pancreatic Neoplasms (drug therapy, radiotherapy, surgery)
• Photons (adverse effects, therapeutic use)
• Prospective Studies
• Radiation Injuries (etiology)