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Neoadjuvant Chemoradiation With Tegafur in Cancer of the Pancreas: Initial Analysis of Clinical Tolerance and Outcome

Calvo, Felipe A. MD, PhD; Matute, Raúl MD*; García-Sabrido, José Luis MD, PhD; Gómez-Espí, Marina MD*; Martínez, Nuria E. MD*; Lozano, Miguel A. MD*; Herranz, Rafael MD*

American Journal of Clinical Oncology: August 2004 - Volume 27 - Issue 4 - p 343-349
doi: 10.1097/01.COC.0000071462.12769.35
Original Article

The early institutional experience in the neoadjuvant treatment of potentially resectable pancreatic carcinoma using oral Tegafur as radioenhancing agent is analyzed. Fifteen patients (10 male and 5 female, mean age of 61 years) were treated over a 30-month period. Tegafur dose was 1,200 mg/d along the external radiotherapy period (45–55 consecutive days). Preoperative radiotherapy achieved a total dose of 45 to 50 Gy (1.8 Gy/d). Intraoperative electron boost (10–15 Gy) was delivered at the time of surgery. Hematologic tolerance showed a significant decrease of neutrophil and platelet counts from the outset to the end of the neoadjuvant period (p = 0.001 and p = 0.004, respectively). Five grade III vomiting episodes (33%) were also registered. In 9 patients (60%), surgical resection was performed after chemoradiation. Three complete pathologic responses (pT0 specimens) were identified; in seven cases, the resection achieved tumor-free surgical margins of the specimen. With a median follow-up of 21 months, median survival time was 17 months, with actuarial rates of 45% at 1 year and 24% at 3 years. Median survival for the resected patients was 23 months, and for the unresected patients median survival was 8 months (p = 0.02). The overall median survival in completely resected patients was 28 months, with a 71% survival rate at 1 and 3 years. It is concluded that the treatment scheme described is feasible and acceptably tolerated. The use of oral Tegafur seems to induce results similar to those of other therapeutic protocols using intravenous radioenhancing chemotherapy.

From the *Radiation Oncology Service, †Oncology Department, and ‡General Surgery Department III, Hospital General Universitario Gregorio Marañón, 28027 Madrid, Spain.

Reprints: Dr. Felipe A. Calvo, Department of Oncology, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo No. 46, 28027 Madrid, Spain. E-mail:

© 2004 Lippincott Williams & Wilkins, Inc.