A study of radiotherapy modalities combined with continuous 5-FU infusion for locally advanced gastrointestinal malignancies S.I. Shibata a, *, R. Pezner b , D. Chu b , J.H. Doroshow a , W.A. Chow a , L.A. Leong a , K.A. Margolin a , M.V. McNamara a , R.J. Morgan Jr a , J.W. Raschko a , G. Somlo a , M.L. Tetef a , Y. Yen a , T.W. Synold a , L. Wagman b , N. Vora c , M. Carroll a , S. Lin a , J. Longmate d a Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA b Division of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA c Department of Radiation Oncology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA d Department of Biostatistics, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA Accepted for publication 12 November 2003 Available online 5 June 2004 KEYWORDS Intraoperative radiation therapy; Pancreatic cancer; Colorectal cancer; Radiation sensitization Summary Aim. We describe the feasibility of combining infusional 5-fluorouracil (5-FU) with intraoperative radiation therapy (IORT). Methods. Patients with surgically resectable locally advanced gastrointestinal cancers were treated concurrently during surgery with IORT and a 72 h infusion of 5-FU. Patients without previous external beam radiation therapy (EBRT) were subsequently treated with EBRT (40–50 Gy) concurrent with a 21-day continuous infusion of 5-FU. Pancreatic, gastric, duodenal, ampullary, recurrent colorectal, and recurrent anal cancer were included. Results. During IORT/5-FU, no chemotherapy-related grade III or IV hemato- logic or gastrointestinal toxicity was noted. Post-surgical recovery or wound healing was not affected. One of nine patients who received post-operative radiation required a treatment break. During follow-up, there were more complications in patients with pelvic tumours, especially those with previous radiation. Nine patients have had local and/or local regional recurrences, two of these in the IORT field. Conclusions. Treatment with a combination of IORT and 5-FU followed by EBRT and 5-FU is feasible. However, long-term complications may be increased in previously irradiated recurrent pelvic tumours. Q 2004 Elsevier Ltd. All rights reserved. EJSO (2004) 30, 650–657 www.ejso.com 0748-7983/$ - see front matter Q 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejso.2003.11.012 *Corresponding author. Tel.: þ1-626-359-8111; fax: þ 1-626- 301-8233.