Radiation therapy and 5-fluorouracil in pancreatic cancer

Combination chemotherapy has not been shown to be superior to single- agent 5-fluorouracil (5-FU) in the treatment of metastatic pancreatic cancer. Initial studies from Duke University suggest a role for radiation in the management of locally unresectable presentations of this disease. In vivo studies showed that 5-FU could act as a radiation sensitizer. This concept was subsequently tested in a randomized trial by the Gastrointestinal Tumor Study Group (GITSG). In their studies, combined modality therapy using radiation and 5-FU based chemotherapy prolonged survival in both adjuvant and locally unresectable settings and remains as a standard therapeutic option for appropriately selected patients. Variations on this approach designed to potentiate 5-FU efficacy are under active clinical investigation. This review discusses past and current studies involving 5-FU and radiation and examines some newer strategies involving 5-FU as well as other agents currently of interest.