Tồn tại này không cảm thấy được thời gian đủ dài để tiếp tục theo đuổi chế độ. Một giai đoạn thú vị tôi tiếp cận là để quản lý các gemcitabine ở liều đầy đủ, sau đó leo thang liều bức xạ. Trong trường hợp này, hàng tuần gemcitabine 1000 mg/m2 đã được sử dụng trong một khóa học | 118 Chapter 7 only an month median survival at the expense of serious grade 3 or 4 hematologic toxicity in 21 of patients and grade 3 gastrointestinal toxicity in 10 of patients. This survival was not felt to be long enough to further pursue the regimen. An interesting phase I approach was to administer the gemcitabine at full dose then escalate the radiation dose. In this case weekly gemcitabine of 1000 mg m2 was used during a 3week course of radiation The dose per fraction of radiation for the phase II trial was 36 Gy over 15 fractions Gy per fraction . This trial also employed smaller radiation fields than used on other studies meaning that these data are not applicable to a standard field size. When 41 locally advanced unresectable patients and preoperative resectable patients were treated two patients responded to therapy and 25 had stable disease while 20 had grade 3 gastrointestinal toxicities. The investigators have now successfully added cisplatin to this gemcitabine radiation Finally in at least one trial adding gemcitabine to standard infusional 5-FU radiation was not well Conclusion Locally advanced disease patients are currently treated with chemotherapy alone included with patients on metastatic trials or with chemotherapy radiation. The current ECOG randomized trial will help to define the role of chemoradiation vs chemotherapy alone by testing gemcitabine with or without radiation therapy. Other groups are trying to improve upon chemoradiation by adding newer agents such as cetuximab erlotinib and bevacizumab. Resectable Disease Patients with resectable disease represent a small subset 10 of all patients of pancreatic cancer patients. However even if the cancer can be completely removed with negative margins no microscopic or macroscopic residual disease at the cut edges the majority still have recurrences with only 20 of patients alive at 5 years. Adjuvant therapy is the term used for treatment .
