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Multimodal therapies in ductal pancreatic cancer

The future

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Summary

Conclusions. Intra-arterial infusion chemotherapy via the celiac axis combined with external beam radiotherapy might be an effective method for palliative and perioperative multimodal treatment in pancreatic cancer. To improve the dismal prognosis in resectable and nonresectable pancreatic cancer, the results of multimodal palliative, adjuvant, and neoadjuvant therapies were reviewed and put into perspective with the results of two intra-arterial palliative and adjuvant treatment studies conducted at our department. The benefits and pitfalls of each method were outweighted, resulting in a concept for performing intra-arterial chemotherapy with radiotherapy in nonresectable stage UICC-III pancreatic cancer that eventually will be developed as a combined neoadjuvant/adjuvant treatment of all potentially resectable ductal pancreatic carcinomas.

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References

  1. Beger HG, Büchler MW, Friess H. Chirurgische Ergebuisse und Indikation zu adjuvanten Mabnahmen beim Pankreascarcinom.Chirurg 1994; 65: 246–252.

    PubMed  CAS  Google Scholar 

  2. Bruckner HW, Kalnicki S, Dalton J, Schwartz GK, Chesser MR, Mandeli J, Janus C. Combined modality therapy increasing local control of pancreatic cancer.Cancer Invest 1993; 11: 241–246.

    Article  PubMed  CAS  Google Scholar 

  3. Bruckner HW, Kalnicki S, Dalton J, Snady H, Schwartz GK, Chesser MR, Lehrer D, Mandeli J, Harpaz N, Janus C. Survival after combined modality therapy for pancreatic cancer.J Clin Gastroenterol 1993; 16: 199–203.

    Article  PubMed  CAS  Google Scholar 

  4. Bruckner HW, Snady H, Cooperman A, Chesser MR, Gattani M, Dalton J, Lavangini P, Schindelheim GS, Kelliher SK, Mandeli J. Combined modality therapy for effective local control in stage II and III unresectable pancreatic carcinoma.Proc ASCO 1995; 14: 216(abstract).

    Google Scholar 

  5. Aigner KR, Gailhofer S. Regional Chemotherapy for nonresectable, locally metastasized pancreatic cancer—four studies including 164 cases.Reg Cancer Treat Suppl 1993; 1:2(abstract).

    Google Scholar 

  6. Link KH, Gansauge F, Pillasch J, Rilinger N, Büchler M, Beger HG. Regional treatment of advanced nonresectable and of resected pancreatic cancer via celiac axis infusion. First results of a single institution study.Dig Surg 1994; 11: 414–419.

    Article  Google Scholar 

  7. Gansauge F, Link KH, Rilinger N, Kunz R, Beger HG. Adjuvante regionale Chemotherapie beim resezierten fortgeschrittenen Pankreascarcinom.Chirurg 1996; 67: 362–365.

    PubMed  CAS  Google Scholar 

  8. Weiss L, Harlos JP, Hartveit F, Maartmann-Moe H, Svendsen E, et al. Metastatic pattern from cancers of the pancreas: an analysis of 558 autopsies.Reg Cancer Treat 1992; 4: 265–271.

    Google Scholar 

  9. Andrén-Sandberg A, Westerdahl J, Ihse I. Recurrence after pancreatectomy for pancreatic cancer.Digestion 1992; 52: 67–137 (abstract).

    Google Scholar 

  10. Griffin JF, Smalley SR, Jewell W. Patterns of failure after curative resection of pancreatic carcinoma.Cancer 1990; 66: 56–61.

    Article  PubMed  CAS  Google Scholar 

  11. Weiss SM, Skibber JM, Mohiuddin M, Rosato FE. Rapid intra-abdominal spread of pancreatic cancer.Arch Surg 1985; 120: 415,416.

    PubMed  CAS  Google Scholar 

  12. Warshaw AL, Fernandez-Del Castillo C. Pancreatic carcinoma.N Engl J Med 1992; 326:455–465.

    Article  PubMed  CAS  Google Scholar 

  13. Warshaw AL. Implications of peritoneal cytology for staging of early pancreatic cancer.Am J Surg 1991; 161: 26–30.

    Article  PubMed  CAS  Google Scholar 

  14. Ettinghausen SE. Rationale for intraperitoneal chemotherapy in the treatment of adenocarcinoma of the pancreas.Reg Cancer Treat 1995; 8: 20–24.

    Google Scholar 

  15. Heeckt P, Safi F, Binder T, Büchler M. Freie intraperitoneale Tumorzellen beim Pankreascarcinom—Bedeutung fur den klinischen Verlauf und die Therapie.Chirurg 1992; 63: 563–567.

    PubMed  CAS  Google Scholar 

  16. Ishikawa O, Ohigashi H, Imaoka S, Sasaki Y, Iwanaga T, Matayoshi Y, Inoue T. Is the long-term survival rate improved by preoperative irradiation prior to whipple's procedure for adenocarcinoma of the pancreatic head?Arch Surg 1994; 129:1075–1080.

    PubMed  CAS  Google Scholar 

  17. Ishikawa O, Ohigashi H, Sasaki Y, Furukawa H, Kabuto T, Kameyama M, Nakamori S, Hiratsuka M, Imaoka S. Liver perfusion chemotherapy via both the hepatic artery and portal vein to prevent hepatic metastasis after extended pancreatectomy for adenocarcinoma of the pancreas.Am J Surg 1994; 168: 361–364.

    Article  PubMed  CAS  Google Scholar 

  18. Warshaw AL, Swanson RS. Pancreatic cancer in 1988. Possibilities and probabilities.Ann Surg 1988; 208(5): 541–553.

    Article  PubMed  CAS  Google Scholar 

  19. Arbuck SG. Overview of chemotherapy for pancreatic cancer.Int J Pancreatol 1990; 7: 209–222.

    PubMed  CAS  Google Scholar 

  20. Cascinu S, Fedeli A, Fedeli SL, Catalano G. 5-Fluorouracil, leucovorin and interferon alpha 2b in advanced pancreatic cancer: a pilot study.Ann Onc 1993; 4:83, 84.

    CAS  Google Scholar 

  21. Moore MJ, Erlichman C, Kaizer L, Fine S. A phase II study of 5-fluorouracil, leucovorin and interferon-alpha in advanced pancreatic cancer.Anticancer Drugs 1993; 4: 555–557.

    Article  PubMed  CAS  Google Scholar 

  22. Louvet C, Beerblock K, De Gramont A, Varette C, et al. High-dose folinic acid 5-fluorouracil bolus and infusion in advanced pancreatic adenocarcinoma: a pilot study.Eur J Cancer 1993; 29A: 1217, 1218.

    Article  PubMed  CAS  Google Scholar 

  23. Bernhard H, Jager AE, Bernhard G, Heike M, Klein O, Riemann JF. Treatment of advanced pancreatic cancer with 5-fluorouracil, folinic acid and interferon alpha-2A: results of a phase II trial.Br J Cancer 1995; 71: 102–105.

    PubMed  CAS  Google Scholar 

  24. Isacoff WH, Reber H, Tompkins R, Zinner MJ, Brody M. Continuous infusion (CI) 5-fluorouracil (5-FU), calcium leucovorin (LV), mitomycin-c (Mito C), and dipyridamole (D); treatment for patients with locally advanced pancreatic cancer.Proc ASCO 1995; 14: 198(abstract).

    Google Scholar 

  25. Rougier P, Zarva JJ, Ducreux M, Basile M, Pignon JP, et al. Phase II study of cisplatin and 120-hour continuous infusion of 5-fluorouracil in patients with advanced pancreatic adenocarcinoma.Ann Onc 1993; 4: 333–336.

    CAS  Google Scholar 

  26. Palmer KR, Kerr M, Knowles G, Cull A, Carter DC, Leonard RCF. Chemotherapy prolongs survival in inoperable pancreatic carcinoma.Br J Surg 1994; 81: 882–885.

    Article  PubMed  CAS  Google Scholar 

  27. Moore M, Andersen J, Burris H, et al. A randomized trial of gemcitabine (GEM) versus 5-FU as first line therapy in advanced pancreatic cancer.Proc ASCO 1995; 14: 199(abstract).

    Google Scholar 

  28. Link KH, Staib L, Beger HG. Influence of exposure concentration and exposure time cxt on toxicity of cytostatic drugs to HT29 human colorectal carcinoma cells.Reg Cancer Treat 1989; 2: 189–197.

    Google Scholar 

  29. Link KH, Hepp G, Butzer Z, Staib L, Kunz R, Pillasch J, Gansauge F, Schaller C, Beger HG. Rationales for intraperitoneal chemotherapy: chemosensitivity testing and pharmacokinetic considerations—clinical experience with intraperitoneal chemotherapy.Acta Chir Austriaca 1995; 27: 95–100.

    Article  Google Scholar 

  30. Link KH, Kindler D, Hummel M, Büchler M. Dose response treatment studies with two pancreatic carcinoma cell lines in vitro.Digestion 1992; 52:102(abstract).

    Google Scholar 

  31. Rougier P, Laplanche A, Huguier M, Hay JM, Ollivier JM, Escat J, ea al. Hepatic arterial infusion of floxuridine in patients with liver metastases from colorectal carcinoma: long-term results of a prospective randomized Trial.J Clin Oncol 1992; 10: 1112–1118.

    PubMed  CAS  Google Scholar 

  32. Allen-Mersh TG, Earlam S, Fordy C, Abrams K, Houghton J. Quality of life and survival with continuous hepatic-artery floxuridine infusion for colorectal liver metastases.Lancet 1994; 344: 1255–1260.

    Article  PubMed  CAS  Google Scholar 

  33. Donatini B, Rougier P. Anatomical basis for pancreatic locoregional chemotherapy.Reg Cancer Treat 1992; 4: 272–276.

    Google Scholar 

  34. Gansauge F, Link KH, Rilinger N, Kunz R, Beger HG. Regionale Chemotherapie beim fortgeschrittenen Pankreaskarzinom.Med Klin 1995; 90: 501–505.

    CAS  Google Scholar 

  35. Ohigashi H: Pancreatic cancer: arterial infusion chemotherapy for advanced pancreatic cancer, inArterial Infusion Chemotherapy, Taguchi T, Nakamura H, eds. Jpn. J. Cancer and Chemother. Pub. Inc., Tokyo, Japan, 1995, pp 416–426.

    Google Scholar 

  36. Moertel CG, Frytak S, Hahn RG, O'Connell MJ, Reitemeir RJ, Rubin J, et al. (Gastrointestinal Tumor Study Group). Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 reds) radiation alone, moderate dose radiation (4000 reds +5-fluorouracil) and high dose radiation and 5-fluorouracil.Cancer 1981; 48: 1705–1710.

    Article  PubMed  CAS  Google Scholar 

  37. Gastrointestinal Tumor Study Group. Treatment of locally resectable carcinoma of the pancreas: comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone.J Natl Cancer Inst 1988; 80: 751–755.

    Article  Google Scholar 

  38. Moertel CG, Gunderson LL, Mailliard JA, Mc Kenna PJ, Martenson JA, Burch PA, Cha SS. Early evaluation of combined fluorouracil and leucovorin as a radiation enhancer for locally unresectable, residual, or recurrent gastrointestinal carcinoma.J Clin Oncol 1994; 12: 21–27

    PubMed  CAS  Google Scholar 

  39. Bodner E. Intraoperative Bestrahlung helm Pankreascarcinom.Chirurg 1994; 65: 241–245.

    PubMed  CAS  Google Scholar 

  40. Bakkevold KE, Arnesjo B, Dahl O, Kambestad B. Adjuvant combination chemotherapy (AMF) following radical resection of carcinoma of the pancreas and papilla of Vater: results of a controlled, prospective randomised multicentre study.Eur J Cancer 1993; 29A: 698–703.

    Article  PubMed  CAS  Google Scholar 

  41. Gastrointestinal Tumor Study Group. Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer.Cancer 1987; 59: 2006–2010.

    Article  Google Scholar 

  42. Douglass HO Jr, Stablein D. Ten year follow up of first generation adjuvant studies of the Gastrointestinal Tumor Study Group, inAdjuvant Therapy of Cancer, Jones S, Salmon S., eds., 1990; pp. 405–415.

  43. Douglass HO Jr. Adjuvant therapy for pancreatic cancer.World J Surg 1995; 19: 270–274.

    Article  PubMed  Google Scholar 

  44. Foo ML, Gunderson LL, Nagorney DM, McLlrath DC, Heerden van JA, Robinow JS, Kvols LK, Garton GR, Martenson JA, Cha SS. Patterns of failure in grossly resected pancreatic ductal adenocarcinoma treated with adjuvant irradiation +/-5 fluorouracil.Int J Radiation Oncol Biol Phys 1993; 26: 483–489.

    CAS  Google Scholar 

  45. Riethmüller G, Schneider-Gadicke E, Schlimok G, Schmiegel W, Raab R, Hoffken K, Gruber R, Pichlmaier H, Hirche H, Pichlmayr R, Buggisch R, Witte J. Randomised trial of monoclonal antibody for adjuvant therapy of resected Dukes' C colorectal carcinoma.Lancet 1994; 34: 1177–1183.

    Article  Google Scholar 

  46. Büchler M, Friess H, Schultheis KH, Gebhardt C, Muhrer KH, Winkelmann M, Wagener T, Klapdor R, Schulz G, Kaul M, Beger HG. A randomized controlled trial of passive immunotherapy (murine monoclonal antibody 494/32) in resectable pancreatic cancer.Cancer 1991; 68: 1507–1512.

    Article  PubMed  Google Scholar 

  47. Goldie JH, Coldman AJ. Application of theoretical models to chemotherapy protocol design.Cancer Treat Rep 1986; 70: 127–131.

    PubMed  CAS  Google Scholar 

  48. Hoffman JP, Weese JL, Solin LJ, Agarwal P, Engstrom P, Scher R, Paul AR, Litwin S, Watts P, Eisenberg BL. A single institutional experience with preoperative chemoradiotherapy for stage I–III pancreatic adenocarcinoma.Am Surg 1993; 59: 772–780.

    PubMed  CAS  Google Scholar 

  49. Hoffman JP, Weese JL, Lipsitz S, Solin LJ, Benson AB, Pisansky TM, Dalton A. Preoperative chemoradiation for patients with resectable pancreatic adenocarcinoma: an eastern cooperative oncology group (ECOG) phase II study.Proc ASCO 1995; 14: 201 (abstract).

    Google Scholar 

  50. Yeung RS, Weese JL, Hoffman JP, Solin LJ, Paul AR, Engstrom PF, Litwin S, Kowalyshyn MJ, Eisenberg BL. Neoadjuvant chemoradiation in pancreatic and duodenal carcinoma—a phase II study.Cancer 1993; 72: 2124–2133.

    Article  PubMed  CAS  Google Scholar 

  51. Baumel H, Huguier M, Manderscheid JC, Fabre JM, Houry S, Fagot H. Results of resection for cancer of the exocrine pancreas: a study from the French Association of Surgery.Br J Surg 1994; 81: 102–107.

    Article  PubMed  CAS  Google Scholar 

  52. Gall FP, Zirngibl H. Maligne Tumoren des Pankreas und der periampullaren Region, inChirurgische Onkologie— Histologie-und Stadiengerechte Therapie Maligner Tumoren, Gall FP, Hermanek P, Tonak J, eds., Springer-Verlag, Berlin, 1986; pp. 416–460.

    Google Scholar 

  53. Gudjonsson B. Cancer of the pancreas: 50 years of surgery.Cancer 1987; 60: 2284–2303.

    Article  PubMed  CAS  Google Scholar 

  54. Farber LA, Fier CM, Mandeli J, Bruckner HW. Efficacy, cost and quality of life considerations applicable to periadjuvant therapy for pancreatic cancer (Sixth International Congress on Anti-Cancer Treatment).SOMPS 1996; 118(abstract.)

  55. Ohigashi H, Ishikawa O, Nakamori S, Sasaki Y, Matsutani S, Kameyama M, et al. Evaluation of intra-arterial infusion chemotherapy and radical pancreatectomy in patients with locally advanced pancreatic cancer.Gan To Kagaku Ryoho 1993; 20: 1672–1675.

    PubMed  CAS  Google Scholar 

  56. Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment.Cancer 1981; 47: 207–214.

    Article  PubMed  CAS  Google Scholar 

  57. Link KH, Kreuser ED, Safi F, Ullrich J, Schalhorn A, Schmoll E, Beger HG. Die intraarterielle Chemotherapie mit 5-FU und Folinsaure (FA, Rescuvolin) im Therapiekonzept bei nicht resektablen kolorektalen Lebermetastasen.Tumordiagn Ther 1993; 14: 224–231.

    Google Scholar 

  58. Fujimoto S, Shrestha RD, Kokubun M, Kobayashi K, Kinchi S, Konno C, Ohta M, Tahahashi M, Kitsukawa Y, Mizutani M, Chikenji T, Okni K. Positive results of combined therapy of surgery and intraperitoneal hyperthermic perfusion for far-advanced gastric cancer.Ann Surg 1990; 212: 592–596.

    Article  PubMed  CAS  Google Scholar 

  59. Hagiwara A, Takahashi T, Kojima O, Sawai K, Yamaguchi T, Yamane T, Taniguchi H, Kitamura K, Noguchi A, Seiki K, Sakakura C. Prophylaxis with carbon-absorbed mitomycin against peritoneal recurrence of gastric cancer.Lancet 1992; 339: 629–631.

    Article  PubMed  CAS  Google Scholar 

  60. Sugarbaker PH, Gianola FJ, Speyer JL, Wesley R, Barofsky I, Myers CE. Prospective randomized trial of intravenous v. intraperitoneal 5-FU in patients with advanced primary colon or rectal cancer.Sem Oncol 1985; XII(3): 101–111.

    Google Scholar 

  61. Fujimoto S, Shrestha RD, Kokubun M, Ohta M, Takahashi M, Kobayashi K, Kiuchi S, Okui K, Miyoshi T, Arimizu N, Takamizawa H. Intraperitoneal hyperthermic perfusion combined with surgery effective for gastric cancer patients with peritoneal seeding.Ann Surg 1988; 208: 36–41.

    Article  PubMed  CAS  Google Scholar 

  62. Derderian P, Pazdur R, Adjani J, Winn RJ, Abbruzzese J, Patt YZ, et al. Phase II study of 5fluorouracil (SFU) and recombinant alpha-2a interferon (rlFN) in the treatment of advanced pancreatic carcinoma.Proc Am Soc Clin Oncol 1991; 10: 147(abstract).

    Google Scholar 

  63. Schneider CJ, Vaughn DJ, Holroyde C, Armstead B, Haller DG. Phase II trial of 5-FU, leucovorin and interferon alpha 2A in metastatic pancreatic carcinoma: a Penn Cancer Clinical Trials Group (PCCTG) trial.Proc ASCO 1995; 14: 189 (abstract).

    Google Scholar 

  64. DeCaprio JA, Arbuck SG, Mayer RJ. Phase II study of weekly 5-fluorouracil (5FU) and folinic acid (FA) in previously untreated patients with unresectable measurable pancreatic adenocarcinoma.Proc Am Soc Clin Oncol 1989; 8: 100(abstract).

    Google Scholar 

  65. Wils JA, Kok T, Wagener DJT, Selleslags J, Duez N. Activity of cisplatin in adenocarcinoma of the pancreas.Eur J Cancer 1993; 29A: 203, 204.

    Article  PubMed  CAS  Google Scholar 

  66. Bertheault-Cvitkovic F, Levi F, Soussan S, Brienza S, Adam R, Itzhaki M, Misset JL, Bismuth H. Circadian rhythm-modulated chemotherapy with high-dose 5-fluorouracil: a pilot study in patients with pancreatic adenocarcinoma.Eur J Cancer 1993; 29A: 1851–1854.

    Article  PubMed  CAS  Google Scholar 

  67. Bukowski RM, Fleming TR, MacDonald JS, Oishi N, Taylor SA, Baker LH. Evaluation of combination chemotherapy and phase II agents in pancreatic adenocarcinoma.Cancer 1993; 71: 322–325.

    Article  PubMed  CAS  Google Scholar 

  68. Rougier P, Adenis A, Ducreux M, Djazouli K, De Forni K, Adams D, et al. Phase II study of docetaxel in pancreatic adenocarcinoma (PAC): final results after extra-mural review. Department of Internal Medicine (Cancer Research), University of Essen.Proc Second Int-ConfBiol: Prevention and Treatment of GI Malignancies p. 126; 1995.

  69. Wils JA, Kok T, Wagener DJT, Francois E, Selleslags J, Duez N. Phase II trial with ifosfamide in pancreatic cancer.Eur J Cancer 1993; 29A: 290.

    Article  PubMed  CAS  Google Scholar 

  70. Asbury RF, Cnaan A, Johnson L, Harris J, Zaentz SD, Haller DG. An eastern cooperative oncology group phase II study of single agent DHAD, VP-16, aclacinomycin, or spirogermanium in metastatic pancreatic cancer.Am J Clin Oncol 1994; 17: 166–169.

    Article  PubMed  CAS  Google Scholar 

  71. Di Bartolomeo M, Zampino MG, DiLeo A, Bajetta E. Epirubicin, etoposide and cisplatin in advanced pancreatic carcinoma.Eur J Cancer 1993; 29: 1215,1216.

    Article  Google Scholar 

  72. Orita K, Tanaka N, Gochi A, Mori M, Kurimoto M, Minowada J. Clinical trial of immunochemotherapy with OH-1 preparation (IFN-a and TNF-a) and UFT (uraciltegafur) in unresectable pancreatic cancer.Proc ASCO 1995; 14: 162(abstract).

    Google Scholar 

  73. Aigner KR, Muller H, Bassermann R. Intra-arterial chemotherapy with MMC, CDDP and 5-FU for nonresectable pancreatic cancer—a phase II study.Reg Cancer Treat 1990; 3: 1–6.

    Google Scholar 

  74. Miura T. Arterial infusion chemotherapy for pancreatic cancer, inArterial Infusion Chemotherapy, Taguchi T, Nakamura H, eds. Jpn. J. Cancer and Chemother. Pub. Inc., Tokyo, Japan, 1994; 427–436.

    Google Scholar 

  75. Whittington R, Solin L, Mohiuddin ME. Multimodality therapy of localized unresectable pancreatic adenocarcinoma.Cancer 1984; 54: 1991–1998.

    Article  PubMed  CAS  Google Scholar 

  76. Mohiuddin M, Rosato F, Barbot D, Schuricht A, Bierman W, Cantor R, et al. Long-term results of combined modality treatment with J125 implantation for carcinoma of the pancreas.Int J Radiation Oncol Biol Phys 1992; 23: 305–311.

    CAS  Google Scholar 

  77. Wagener DJT, van Hoesel WGCM, Yap SHE. Phase II trial of 5-fluorouracil, adriamycin and cisplatin (FAP) followed by radiation and 5-fluorouracil in locally advanced pancreatic cancer.Cancer Chemother Pharmacol 1989; 25: 131–134.

    Article  PubMed  CAS  Google Scholar 

  78. Kamthan A, Morris JC, Chesser MR, Dalton J, Mandeli J, Bruckner HW. Combined modality therapy for effective local control in stage II and III pancreatic carcinoma.Proc Am Soc Clin Oncol 1992; 11: 160.

    Google Scholar 

  79. Jessup JM, Steele G Jr, Mayer RJ, Posner M, Busse P, Cady B, Stone M, Jenkins R, Osteen R. Neoadjuvant therapy for unresectable pancreatic adenocarcinoma.Arch Surg 1993; 128: 559–564.

    PubMed  CAS  Google Scholar 

  80. Bronn D, Franklin R, Krishnan R, Richardson R, Conlin C. Rapid radiographic response in pancreatic cancer with concurrent continuous infusion (DI) 5-fluorouracil and cisplatin and hyperfractionated radiotherapy.Proc ASCO 1995; 14: 193 (abstract).

    Google Scholar 

  81. Schein PS, Smith FP, Dritschillo A, Stablein D, Ahlgren DS. 1983. Phase I–II trial of combined modality FAM (5-fluorouracil, adriamycin, mitomycin-C) plus split-course radiation (FAM-RT-FAM) for locally advanced gastric cancer and pancreatic cancer: a mid-Atlantic oncology program study.Proc ASCO 2: 126(Abstract).

    Google Scholar 

  82. Komaki R, Hansen R, Cox JD, Wilson JF. Phase I–II study of prophylactic hepatic irradiation with local irradiation and systemic chemotherapy for adenocarcinoma of the pancreas.Int J Radiation Oncol Biol Phys 1988; 15: 1447–1452.

    CAS  Google Scholar 

  83. Komaki R, Wadler S, Peters T, Byhardt RW, Order S, Gallagher MS. High dose local irradiation plus prophylactic hepatic irradiation and chemotherapy for inoperable adenocarcinoma of the pancreas.Cancer 1992; 69: 2807–2812.

    Article  PubMed  CAS  Google Scholar 

  84. Wagener DJT, Rougier P, Wils JA. Combined chemoradiotherapy for locally advanced pancreatic cancer.Proc ASCO 1992; 11: 166 (Abstract).

    Google Scholar 

  85. Earle JD, Foley JF, Wieand HS, Kvols LK, McKenna PJ, Krook JE, Tschetter LK, Schutt AJ, Twito DI. Evaluation of external-beam radiation therapy plus 5-fluorouracil (5-FU) versus external-beam radiation therapy plus hycanthone (HYC) in confined, unresectable pancreatic cancer.Int Radiation Oncol Biol Phys 1993; 28: 207–211.

    Article  Google Scholar 

  86. Jeekel J, Treurniet-Donker AD. Treatment perspectives in locally advanced unresectable pancreatic cancer.Br J Surg 1991; 78: 1332–1334.

    Article  PubMed  CAS  Google Scholar 

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  1. Department of General Surgery, University of Ulm, Steinhoevelstrasse 9, 89075, Ulm, Germany

    Karl-Heinrich Link, Frank Gansauge, Jürgen Pillasch & Hans-Günther Beger

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Link, KH., Gansauge, F., Pillasch, J. et al. Multimodal therapies in ductal pancreatic cancer. Int J Pancreatol 21, 71–83 (1997). https://doi.org/10.1007/BF02785923

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