• John M Robertson, Jeffrey Margolis, Robert P Jury, Savitha Balaraman, Matthew B Cotant, Samer Ballouz, Iqbal G Boxwala, Ishmael A Jaiyesimi, Laura Nadeau, Maria Hardy-Carlson, Kimberly S Marvin, Michelle Wallace, and Hong Ye.
• Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA. jrobertson@beaumont.edu
• Int. J. Radiat. Oncol. Biol. Phys. 2012 Feb 1; 82 (2): e187-92.

PurposeTo determine the recommended dose of radiotherapy when combined with full-dose gemcitabine and erlotinib for unresected pancreas cancer.Methods And MaterialsPatients with unresected pancreatic cancer (Zubrod performance status 0-2) were eligible for the present study. Gemcitabine was given weekly for 7 weeks (1,000 mg/m(2)) with erlotinib daily for 8 weeks (100 mg). A final toxicity assessment was performed in Week 9. Radiotherapy (starting at 30 Gy in 2-Gy fractions, 5 d/wk) was given to the gross tumor plus a 1-cm margin starting with the first dose of gemcitabine. A standard 3 plus 3 dose escalation (an additional 4 Gy within 2 days for each dose level) was used, except for the starting dose level, which was scheduled to contain 6 patients. In general, Grade 3 or greater gastrointestinal toxicity was considered a dose-limiting toxicity, except for Grade 3 anorexia or Grade 3 fatigue alone.ResultsA total of 20 patients were treated (10 men and 10 women). Nausea, vomiting, and infection were significantly associated with the radiation dose (p = .01, p = .03, and p = .03, respectively). Of the 20 patients, 5 did not complete treatment and were not evaluable for dose-escalation purposes (3 who developed progressive disease during treatment and 2 who electively discontinued it). Dose-limiting toxicity occurred in none of 6 patients at 30 Gy, 2 of 6 at 34 Gy, and 1 of 3 patients at 38 Gy.ConclusionThe results of the present study have indicated that the recommended Phase II dose is 30 Gy in 15 fractions.Copyright © 2012 Elsevier Inc. All rights reserved.

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