Radiation Therapy Plus Chemotherapy in Treating Patients With Pancreatic Cancer

OBJECTIVES:

• Determine the response/remission rate, survival, and degree of local control from interstitial colloidal phosphorus P32 followed by external beam radiotherapy and chemotherapy in patients with unresectable pancreatic cancer.

OUTLINE: Patients are stratified according to prior therapy (yes vs no).

Patients receive dexamethasone intratumorally, then macroaggregated albumin and interstitial phosphorus P32 intratumorally. Most patients receive a second course of this brachytherapy.

Patients then proceed to chemoradiotherapy beginning 7-14 days after brachytherapy. Radiotherapy is administered 5 days a week for 6.4 weeks. Fluorouracil IV is administered every other day for 4 doses during weeks 1 and 2.

Patients are followed monthly for 1 year then every 3 months thereafter.

PROJECTED ACCRUAL: A total of 48 patients will be accrued for this study.

DISEASE CHARACTERISTICS:

• Histologically proven unresectable adenocarcinoma of the pancreas limited to the head, body, or tail of the pancreas

• Diameter no greater than 5 cm
• Volume no greater than 66 mL
• No ascites (with or without tumor cells)
• No endoscopically proven tumor penetration of duodenum or stomach

PATIENT CHARACTERISTICS:

Age:

• 18 and over

Performance status:

• Karnofsky 70-100%

Hematopoietic:

• WBC at least 3,000/mm3
• Platelet count at least 100,000/mm3
• Hemoglobin at least 9 g/dL (transfusion allowed)

Hepatic:

• No hepatic disease
• At least 50% uptake of technetium-sulfur colloid in normal liver if cirrhosis suspected
• No vascular occlusion of portal system

Renal:

• Creatinine no greater than 1.5 mg/dL
• BUN no greater than 25 mg/dL

Other:

• No Crohn's disease, ulcerative colitis, or other inflammatory bowel disease
• Not pregnant

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• Not specified

Chemotherapy:

• If prior chemotherapy, test dose of colloidal phosphorous P32 administered prior to attempted treatment

Endocrine therapy:

• Not specified

Radiotherapy:

• No prior radiotherapy to pancreas, liver, or upper gastrointestinal tract

Surgery:

• No complete surgical resection
• No splenectomy