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Clinical Trial
. 2010 Jun 28:5:60.
doi: 10.1186/1748-717X-5-60.

Helical tomotherapy with concurrent capecitabine for the treatment of inoperable pancreatic cancer

Jeong-Seon Ji  1 , Chi-Wha Han, Jeong-Won Jang, Bo-In Lee, Byung-Wook Kim, Hwang Choi, Ji-Yoon Kim, Young-Nam Kang, Chul-Seung Kay, Ihl-Bohng Choi
Affiliations
Clinical Trial

Helical tomotherapy with concurrent capecitabine for the treatment of inoperable pancreatic cancer

Jeong-Seon Ji et al. Radiat Oncol. .

Abstract

Background: Helical tomotherapy, an advanced intensity-modulated radiation therapy with integrated CT imaging, permits highly conformal irradiation with sparing of normal tissue. Capecitabine, a pro-drug of 5-FU that induces thymidine phosphorylase can achieve higher levels of intracellular 5-FU when administered concurrently with radiation. We evaluated the feasibility as well as the clinical outcome of concurrent administration of capecitabine with tomotherapy in patients with advanced pancreatic cancer.

Methods: Nineteen patients with advanced pancreatic cancer including primarily unresectable disease and recurrence after curative surgery were included in the study. Two planning target volumes (PTV) were entered: PTV1 is gross tumor volume; and PTV2, the volume of the draining lymph nodes. The total doses to target 1 and target 2 were 55 and 50 Gy, respectively. Capecitabine at 1600 mg/m2/day was administered on each day of irradiation.

Results: Twenty six measurable lesions were evaluated. Overall in-field response rate was 42.3%; partial responses were achieved in 53.3% of the pancreatic masses, 28.6% of distant metastatic lesions and 25.0% of regional lymph nodes. The median duration of follow-up after tomotherapy was 6.5 months. None of the lesions showed in-field progression. Treatment was well tolerated with only minor toxicities such as grade 1 nausea (one patient), grade 1 hand-foot syndrome (one patient) and grade 1/2 fatigue (three patients).

Conclusions: Helical tomotherapy with concurrent capecitabine is a feasible option without significant toxicities in patients with advanced pancreatic cancer. We achieved excellent conformal distribution of radiation doses and minimal treatment-related toxicities with promising target volume responses.

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Figures

Figure 1
Figure 1
Distribution of isodoses in the planning of helical tomotherapy in patients with advanced pancreatic cancer; axial (left), coronal (center) and saggital (right) representations. Dose displayed in Gy. The different doses are represented by different colors. Red represents the target volume dose.
Figure 2
Figure 2
Average dose-volume histogram for GTV and organs at risk. Patients were prescribed doses of 55 Gy to PTV1 and 50 Gy to PTV2. GTV = gross tumor volume, PTV = planning target volume.
Figure 3
Figure 3
Abdomenal CTs before (left) and after (right) helical tomotherapy with concurrent capecitabine. Two months after helical tomotherapy the volume of the pancreatic tumor is significantly reduced.
See this image and copyright information in PMC

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