Radiology, Vol 200, 627-630, Copyright © 1996 by Radiological Society of North America
Pancreatic cancer: treatment with neutron irradiation alone and with chemotherapy
L Cohen, FR Hendrickson, AJ Lennox, TK Kroc, MA Hatcher and BR Bennett
Fermilab National Accelerator Laboratory, Neutron Therapy Department, Batavia, IL 60510-0500, USA.
PURPOSE: To evaluate neutron irradiation alone and with chemotherapy to
treat inoperable pancreatic cancer. MATERIALS AND METHODS: Between 1977 and
1994, 173 patients (60 men, 113 women, aged 43-77 years [mean, 59 years])
with unresectable adenocarcinoma of the exocrine pancreas were treated, 106
with neutron irradiation alone and 67 with concomitant chemotherapy
(fluorouracil [5-FU]). At follow-up, which was performed at 2-month
intervals until death (range, 4-64 months), clinical status was recorded,
noting the presence of overt metastasis and the onset of any major
complications. Actuarial (Kaplan-Meier) survival tables were computed for
both groups. RESULTS: For neutron irradiation alone and neutron irradiation
plus chemotherapy, median survival times were 6 months and 9 months,
respectively; actuarial survival rates at 3 years were 0 and 7%,
respectively; major reactions (grade 3 or higher [scale of the Radiation
Therapy Oncology Group and European Organization for Research and Treatment
of Cancer]) occurred in 19 (18%) and 17 (25%) patients, respectively; and
severe complications (grade 4) occurred in five (5%) and four (6%)
patients, respectively. Most deaths were due to metastatic disease rather
than to failure of local control. CONCLUSIONS: Neutron irradiation
obliterated pancreatic adenocarcinoma at the primary site but has no effect
on long-term survival. With more effective concomitant chemotherapy to
prevent metastasis, local control of pancreatic cancer with neutron
irradiation could lead to increased long-term survival.
