Preoperative chemoradiation for XXXX : excessive toxicity of prophylactic hepatic irradiation.

@entity1 @entity5 @entity3 @entity204 @entity420 @entity1487
PURPOSE: In an effort to reduce relapse in the liver and improve survival in @entity1 with potentially resectable @entity420 of the pancreatic head, we combined whole-liver irradiation with our standard preoperative chemoradiation regimen. METHODS AND MATERIALS: Eleven @entity1 with biopsy-proven, potentially resectable @entity420 of the pancreatic head were treated with 50.4 Gy of external beam irradiation to the pancreas (1.8 Gy/day, 5 days/week) and concurrent continuous infusion @entity1487 (300 mg/m2 per day). The liver was treated with 23.4 Gy on Days 8 through 21 (13 fractions; 1.8 Gy/fraction). @entity1 , who upon restaging with radiography and computed tomography were considered to have resectable @entity5 , were subsequently taken to surgery. If, at surgery, @entity5 were resectable, pancreaticoduodenectomy was performed, and 10 Gy of intraoperative electron-beam radiation therapy was delivered to the bed of the resected pancreas. RESULTS: All 11 @entity1 completed chemoradiation. Two treatment-related @entity204 occurred following chemoradiation, prompting premature termination of the study. Of seven @entity1 taken to surgery, four underwent resection. Seven @entity1 have died of disease, five with liver @entity3 . CONCLUSIONS: Prophylactic hepatic chemoradiation, as given in this study, was associated with two treatment-related @entity204 and a higher than expected incidence of subsequent liver @entity3 . Our data do not support the use of this treatment program in @entity1 with @entity420 .
