PMID- 18395362
OWN - NLM
STAT- MEDLINE
DCOM- 20081231
LR  - 20221207
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 72
IP  - 3
DP  - 2008 Nov 1
TI  - Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for 
      locally advanced pancreatic cancer.
PG  - 678-86
LID - 10.1016/j.ijrobp.2008.01.051 [doi]
AB  - PURPOSE: Fractionated radiotherapy and chemotherapy for locally advanced 
      pancreatic cancer achieves only modest local control. This prospective trial 
      evaluated the efficacy of a single fraction of 25 Gy stereotactic body 
      radiotherapy (SBRT) delivered between Cycle 1 and 2 of gemcitabine chemotherapy. 
      METHODS AND MATERIALS: A total of 16 patients with locally advanced, 
      nonmetastatic, pancreatic adenocarcinoma received gemcitabine with SBRT delivered 
      2 weeks after completion of the first cycle. Gemcitabine was resumed 2 weeks 
      after SBRT and was continued until progression or dose-limiting toxicity. The 
      gross tumor volume, with a 2-3-mm margin, was treated in a single 25-Gy fraction 
      by Cyberknife. Patients were evaluated at 4-6 weeks, 10-12 weeks, and every 3 
      months after SBRT. RESULTS: All 16 patients completed SBRT. A median of four 
      cycles (range one to nine) of chemotherapy was delivered. Three patients (19%) 
      developed local disease progression at 14, 16, and 21 months after SBRT. The 
      median survival was 11.4 months, with 50% of patients alive at 1 year. Patients 
      with normal carbohydrate antigen (CA)19-9 levels either at diagnosis or after 
      Cyberknife SBRT had longer survival (p <0.01). Acute gastrointestinal toxicity 
      was mild, with 2 cases of Grade 2 (13%) and 1 of Grade 3 (6%) toxicity. Late 
      gastrointestinal toxicity was more common, with five ulcers (Grade 2), one 
      duodenal stenosis (Grade 3), and one duodenal perforation (Grade 4). A trend 
      toward increased duodenal volumes radiated was observed in those experiencing 
      late effects (p = 0.13). CONCLUSION: SBRT with gemcitabine resulted in comparable 
      survival to conventional chemoradiotherapy and good local control. However, the 
      rate of duodenal ulcer development was significant.
FAU - Schellenberg, Devin
AU  - Schellenberg D
AD  - Department of Radiation Oncology, Stanford University School of Medicine, 
      Stanford, CA, USA.
FAU - Goodman, Karyn A
AU  - Goodman KA
FAU - Lee, Florence
AU  - Lee F
FAU - Chang, Stephanie
AU  - Chang S
FAU - Kuo, Timothy
AU  - Kuo T
FAU - Ford, James M
AU  - Ford JM
FAU - Fisher, George A
AU  - Fisher GA
FAU - Quon, Andrew
AU  - Quon A
FAU - Desser, Terry S
AU  - Desser TS
FAU - Norton, Jeffrey
AU  - Norton J
FAU - Greco, Ralph
AU  - Greco R
FAU - Yang, George P
AU  - Yang GP
FAU - Koong, Albert C
AU  - Koong AC
LA  - eng
PT  - Clinical Trial, Phase II
PT  - Journal Article
DEP - 20080418
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
RN  - 0 (Antineoplastic Agents)
RN  - 0W860991D6 (Deoxycytidine)
RN  - 0 (Gemcitabine)
SB  - IM
MH  - Adenocarcinoma/diagnostic imaging/*drug therapy/mortality/radiotherapy/surgery
MH  - Aged
MH  - Aged, 80 and over
MH  - Antineoplastic Agents/*therapeutic use/toxicity
MH  - Combined Modality Therapy
MH  - Deoxycytidine/*analogs & derivatives/therapeutic use/toxicity
MH  - Disease Progression
MH  - Female
MH  - Gastrointestinal Diseases/chemically induced
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pancreatic Neoplasms/diagnostic imaging/*drug 
      therapy/mortality/radiotherapy/surgery
MH  - Radiography
MH  - *Radiosurgery
MH  - Radiotherapy Dosage
MH  - Survival Analysis
MH  - Survivors
MH  - Gemcitabine
EDAT- 2008/04/09 09:00
MHDA- 2009/01/01 09:00
CRDT- 2008/04/09 09:00
PHST- 2007/10/11 00:00 [received]
PHST- 2007/12/12 00:00 [revised]
PHST- 2008/01/21 00:00 [accepted]
PHST- 2008/04/09 09:00 [pubmed]
PHST- 2009/01/01 09:00 [medline]
PHST- 2008/04/09 09:00 [entrez]
AID - S0360-3016(08)00227-7 [pii]
AID - 10.1016/j.ijrobp.2008.01.051 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2008 Nov 1;72(3):678-86. doi: 
      10.1016/j.ijrobp.2008.01.051. Epub 2008 Apr 18.