This prospective randomized trial was undertaken to determine the added efficacy of 32P in treating locally advanced unresectable pancreatic cancer. Thirty patients with biopsy proven locally advanced unresectable adenocarcinoma of the pancreas were assessable after receiving 5-fluorouracil and radiation therapy with or without 32P, followed by gemcitabine. Intratumoral 32P dose was determined by tumor size and volume and was administered at months 0, 1, 2, 6, 7, and 8. Tumor cross-sectional area and liquefaction were determined at intervals by computed tomography scan. Tumor liquefaction occurred in 78% of patients receiving 32P and in 8% of patients not receiving 32P, although tumor cross-sectional area did not decrease. Serious adverse events occurred more often per patient for patients receiving 32P (4.2∈±∈3.1 vs. 1.8∈±∈1.9; p∈=∈0.03) leading to more hospitalizations. Death was because of disease progression (23 patients), gastrointenstinal hemorrhage (4 patients), and stroke (1 patient). One patient not receiving 32P and one receiving 32P are alive at 28 and 13 months, respectively. 32P did not prolong survival (7.4∈±∈5.5 months with 32P vs. 11. 5∈±∈8.0 months without 32P, p∈=∈0.16). 32P promoted tumor liquefaction, but did not decrease tumor size. Intratumoral 32P was associated with more serious adverse events and did not improve survival for locally advanced unresectable pancreatic cancer.
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