Capecitabine and Concurrent Radiation in Patients with Locally Advanced Irresectable Pancreatic Cancer

Pancreatic carcinoma is the fourth leading cause of death worldwide [21]. Despite certain advances in diagnosis, surgical procedures and chemotherapy, the prognosis of pancreatic cancer patients remains dismal [27]. Resection of the tumor at an early stage of the disease is the only curative treatment option. Unfortunately, as pancreatic cancer lacks early symptoms, less than 25% of patients undergo complete resection, whereas the majority of the rest have locally advanced unresectable disease [11]. A number of studies have shown little benefit with various single agent and combination chemotherapies for patients with locally advanced disease [4,10,25] whereas concurrent flurouracil and ionizing radiation result in a twofold increase in median survival [9,17]. Accordingly, many oncologists consider it standard therapy for patients with locally advanced unresectable pancreatic carcinoma. Other radiosensitizing agents coupled with radiotherapy are still under investigation. One of the new agents that have recently become available for the treatment of pancreatic cancer is the purine analog gemcitabine. Experimental data have demonstrated the excellent radio-sensitizing potential of gemcitabine at less than therapeutic concentrations [2,14]. However, studies could not determine the most effective way of how to combine gemcitabine with irradiation [1,15,18]. ABSTRACT