***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: PURPOSE This Phase II trial evaluated the toxicity , local control , and overall survival in patients treated with sequential gemcitabine and linear accelerator-based single-fraction stereotactic body radiotherapy ( SBRT ) .  METHODS AND MATERIAL S Twenty patients with locally advanced , nonmetastatic pancreatic adenocarcinoma were enrolled on this prospect i ve single-institution , institutional review board-approved study . Gemcitabine was administered on Days 1 , 8 , and 15 , and SBRT on Day 29 . Gemcitabine was restarted on Day 43 and continued for 3 - 5 cycles . SBRT of 25 Gy in a single fraction was delivered to the internal target volume with a 2- 3-mm margin using a nine-field intensity-modulated radiotherapy technique . Respiratory gating was used to account for breathing motion . Follow-up evaluations occurred at 4 - 6 weeks , 10 - 12 weeks , and every 3 months after SBRT . RESULTS All patients completed SBRT and a median of five cycles of chemotherapy . Follow-up for the 2 remaining alive patients was 25.1 and 36.4 months . No acute Grade 3 or greater nonhematologic toxicity was observed . Late Grade 3 or greater toxicities occurred in 1 patient ( 5 % ) and consisted of a duodenal perforation ( G4 ) . Three patients ( 15 % ) developed ulcers ( G2 ) that were medically managed . Overall , median survival was 11.8 months , with 1-year survival of 50 % and 2-year survival of 20 % . Using serial computed tomography , the freedom from local progression was 94 % at 1 year . CONCLUSION Linear accelerator-delivered SBRT with sequential gemcitabine result ed in excellent local control of locally advanced pancreatic cancer . Future studies will address strategies for reducing long-term duodenal toxicity associated with SBRT Background First-line treatment with FOLFIRINOX significantly increases overall survival ( OS ) in patients with metastatic pancreatic adenocarcinoma ( PA ) compared with gemcitabine . The aim of this observational cohort was to evaluate the tolerability and efficacy of this regimen in unresectable locally advanced PA ( LAPA ) . Patients and Methods From February 2010 to February 2012 , all consecutive patients from 11 French centers treated by FOLFIRINOX for a histologically proven LAPA were prospect ively enrolled . Unresectability was defined independently by each center ’s multidisciplinary staff at diagnosis . Absence of metastatic disease was confirmed by chest-abdomen-pelvis computed tomography scan . FOLFIRINOX was delivered every 2 weeks as previously reported until progressive disease , major toxicity , or consolidation treatment by radiotherapy and /or surgery . Results Seventy-seven patients were enrolled . They received a median number of five cycles ( 1–30 ) . Grade 3–4 toxicities were neutropenia ( 11 % ) , nausea ( 9 % ) , diarrhea ( 6 % ) , fatigue ( 6 % ) , and anemia ( 1 % ) . Grade 2–3 sensory neuropathy occurred in 25 % of patients . No toxic death was reported and only 6 % of patients had to stop treatment because of toxicity . Disease control rate was 84 with 28 % of objective response ( Response Evaluation Criteria in Solid Tumors ) . Seventy-five percent of patients received a consolidation therapy : 70 % had radiotherapy and 36 % underwent a surgical resection , with a curative intent . Within the whole cohort , 1-year OS rate was 77 % ( 95 % CI 65–86 ) and 1-year progression-free survival rate was 59 % ( 95 % CI 46–70 ) . Conclusion First-line FOLFIRINOX for LAPA seems to be effective and have a manageable toxicity profile . These promising results will have to be confirmed in a phase III r and omized trial Background : Through a phase I study with a fixed radiation dose of 54 Gy and escalating doses of weekly gemcitabine , we established a recommended dose of gemcitabine at 250 mg/m2 in combination with radiation therapy for patients with unresectable pancreatic cancer . Objective : The purpose of this phase-II study was to evaluate the safety and efficacy of the regimen which was established in the phase I study . Methods : In all patients with unresectable stage III and limited stage IV pancreatic cancer with no distant metastasis except for para-aortic lymph node involvement at a level as low as the left renal vein , a total dose of 54 Gy  was delivered in 30 fractions of 1.8 Gy/d . Gemcitabine was given weekly at a dose of 250 mg/m2 . Results : Between December 2002 and March 2006 , 22 patients were enrolled in this study and one withdrew after enrollment . Twenty of 21 patients ( 95 % ) completed the protocol therapy . Radiologic partial response was observed in 6 and stable disease was noted in 15 . Normalization of the tumor marker ( CA19 - 9 ) occurred in 61 % of patients . The 1-year survival rate was 74 % and the median survival time was 16.6 months . The major toxicity was leucopenia ; grade 3 in 14 ( 67 % ) , anorexia grade 3 in 2 ( 9.5 % ) , and grade 3 gastric ulcer in 2 ( 10 % ) in National Cancer Institute 's Common Terminology Criteria for Adverse Events version 3.0 ( NCI-CTCAE v3.0 ) . Neither grade 4 nor 5 was recognized . Conclusion : Treatment with gemcitabine combined with radiation therapy according to the present schedule is well tolerated and can provide prolonged survival in patients with localized , unresectable pancreatic cancer Summary Background In the UK , chemotherapy is the st and ard treatment for inoperable , locally advanced , non-metastatic pancreatic cancer .  Chemoradiotherapy is also an acceptable treatment option , for which gemcitabine , fluorouracil , or capecitabine can be used as concurrent chemotherapy agents . We aim ed to assess the activity , safety , and feasibility of both gemcitabine-based and capecitabine-based chemoradiotherapy after induction chemotherapy for patients with locally advanced pancreatic cancer . Methods In this open-label , r and omised , two-arm , phase 2 trial , patients aged 18 years or older with histologically proven , locally advanced pancreatic cancer ( with a tumour diameter of 7 cm or less ) were recruited from 28 UK centres between Dec 24 , 2009 and Oct 25 , 2011 . After 12 weeks of induction gemcitabine and capecitabine chemotherapy ( three cycles of gemcitabine [ 1000 mg/m2 on days 1 , 8 , 15 of a 28-day cycle ] and capecitabine [ 830 mg/m2 twice daily on days 1–21 of a 28-day cycle ] ) , patients with stable or responding disease , tumour diameter of 6 cm or less , and WHO performance status 0–1 were r and omly assigned to receive a further cycle of gemcitabine and capecitabine chemotherapy followed by either gemcitabine ( 300 mg/m2 once per week ) or capecitabine ( 830 mg/m2 twice daily , Monday to Friday only ) , both in combination with radiation ( 50·4 Gy in 28 fractions ) . R and omisation ( 1:1 ) was done via a central computerised system and used stratified minimisation . The primary endpoint was 9-month progression-free survival , analysed by intention to treat including only those patients with valid CT assessment s. This trial is registered with IS RCT N , number 96169987 . Findings 114 patients were registered and 74 were r and omly allocated ( 38 to the gemcitabine group and 36 to the capecitabine group ) . After 9 months , 22 of 35 assessable patients ( 62·9 % , 80 % CI 50·6–73·9 ) in the capecitabine group and 18 of 35 assessable patients ( 51·4 % , 39·4–63·4 ) in the gemcitabine group had not progressed . Median overall survival was 15·2 months ( 95 % CI 13·9–19·2 ) in the capecitabine group and 13·4 months ( 95 % CI 11·0–15·7 ) in the gemcitabine group ( adjusted hazard ratio [ HR ] 0·39 , 95 % CI 0·18–0·81 ; p=0·012 ) . 12-month overall survival was 79·2 % ( 95 % CI 61·1–89·5 ) in the capecitabine group and 64·2 ( 95 % CI 46·4–77·5 ) in the gemcitabine group . Median progression-free survival was 12·0 months ( 95 % CI 10·2–14·6 ) in the capecitabine group and 10·4 months ( 95 % CI 8·9–12·5 ) in the gemcitabine group ( adjusted HR 0·60 , 95 % CI 0·32–1·12 ; p=0·11 ) . Eight patients in the capecitabine group had an objective response at 26 weeks , as did seven in the gemcitabine group . More patients in the gemcitabine group than in the capecitabine group had grade 3–4 haematological toxic effects ( seven [ 18 % ] vs none , p=0·008 ) and non-haematological toxic effects ( ten [ 26 % ] vs four [ 12 % ] , p=0·12 ) during chemoradiation treatment ; the most frequent events were leucopenia , neutropenia , and fatigue . Two patients in the capecitabine group progressed during the fourth cycle of induction chemotherapy . Of the 34 patients in the capecitabine group who received chemoradiotherapy , 25 ( 74 % ) received the full protocol dose of radiotherapy , compared with 26 ( 68 % ) of 38 patients in the gemcitabine group . Quality -of-life scores were not significantly different between the treatment groups . Interpretation Our results suggest that a capecitabine-based regimen might be preferable to a gemcitabine-based regimen in the context of consolidation chemoradiotherapy after a course of induction chemotherapy for locally advanced pancreatic cancer . However , these findings should be interpreted with caution because the difference in the primary endpoint was non-significant and the number of patients in the trial was small . Funding Cancer Research UK Objective A Phase II study was conducted at Indiana University to evaluate the safety and efficacy of combined weekly Gemcitabine ( GEM ) with external beam radiotherapy ( RT ) in unresectable , locally advanced pancreatic cancer ( LAPC ) . Methods Eligible patients had biopsy-proven LAPC without evidence of metastatic disease . In part A of the treatment plan , patients received GEM 600 mg/m2 IV weekly , with concurrent RT ( 50.4 Gy in 28 fractions , 1.8 Gy/d , 5 days per week ) . Part B of the treatment plan began approximately 4 weeks after completing part A : patients without disease progression received weekly GEM 1000 mg/m2 on days 1 , 8 , and 15 of a 28-day cycle for 6 cycles or until disease progression . Results From April 2001 to June 2003 , of 28 patients evaluated , 24 ( 86 % ) completed part A. About 22 patients had grade 3 toxicities , primarily hematologic ( 43 % ) and gastrointestinal ( 36 % ) . Three patients ( 11 % ) had grade 4 toxicities ( one each for hyperbilirubinemia , infection , and dyspnea ) . The median follow-up was 10 months ( 1–63 months ) for all enrolled patients . Six patients ( 21 % ) had a radiologic partial response , 16 ( 57 % ) had stable disease , 5 ( 18 % ) had progressive disease , and 1 patient ( 4 % ) had an unevaluable response at last follow-up . Four patients ( 14 % ) underwent surgical resection ( 2 with R0 resection ) . Median time to progression was 6 months ( 0–36 months ) . Median survival time was 10.3 months ( 95 % confidence interval , 7.9–14.6 months ) . The 1- and 2-year actuarial survival rates were 30 % and 11 % . At last analysis , all but 2 patients died . Conclusion The activity and toxicity profile of combination GEM and RT indicates that this can be safely administered for patients with LAPC PURPOSE Fractionated radiotherapy and chemotherapy for locally advanced pancreatic cancer achieves only modest local control . This prospect i ve trial evaluated the efficacy of a single fraction of 25 Gy stereotactic body radiotherapy ( SBRT ) delivered between Cycle 1 and 2 of gemcitabine chemotherapy . METHODS AND MATERIAL S A total of 16 patients with locally advanced , nonmetastatic , pancreatic adenocarcinoma received  gemcitabine with SBRT delivered 2 weeks after completion of the first cycle . Gemcitabine was resumed 2 weeks after SBRT and was continued until progression or dose-limiting toxicity . The gross tumor 
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These results suggest that SBRT for LAPC may result in a modest improvement in 2-year OS with decreased rates of acute grade 3/4 toxicity and no change in 1-year-OS or late toxicity .