Cancer Management Chapter 11: Pancreatic, neuroendocrine GI, and adrenal cancers

LBA4505, 2009). Chemoradiation The addition of chemotherapy to radiation therapy has been shown to improve the survival of patients with unresectable pancreatic adenocarcinoma, with moderate doses of radiation only slightly less effective than higher doses. In a GITSG trial of unresectable disease, moderate-dose radiation (4,000 cGy) with 5-FU chemotherapy significantly improved survival, as compared with higher doses of radiation (6,000 cGy) and no chemotherapy (median survival, 9.6 vs 5.2 months). The GITSG has also compared chemotherapy plus irradiation with chemotherapy alone and demonstrated a significant improvement with combined-modality therapy (median survival, 42 vs 32 weeks). Based on these data, except in a protocol setting, the palliative management of a patient with unresectable pancreatic adenocarcinoma who has significant local symptoms should probably consist of moderate doses of radiation (4,000–5,000 cGy) in conjunction with 5-FU–based