PREOPERATIVE CHEMORADIOTHERAPY FOR LOCALIZED PANCREATIC-CARCINOMA - APERSPECTIVE

BACKGROUND. The role of chemotherapy (CTX) in the treatment of localiz ed adenocarcinoma of the pancreas must be enhanced if current results are to be surpassed. It is postulated that histologic response to vari ous chemotherapeutic agents may offer an assessable endpoint intermedi ate to and perhaps as or more meaningful than survival analysis. METHO DS. A history of trials assessing the value of adjuvant preoperative a nd postoperative chemotherapy and radiation therapy (RT) is provided. Experiences with histologic assessment of treatment response are revie wed. RESULTS. There has been no clear benefit from adjuvant CTX, eithe r when delivered with RT or as postoperative maintenance. Imaging test s were much less sensitive than histologic grading in determining resp onses (7% vs. 71% partial responses) of patients with resected pancrea tic cancers previously treated with RT/CTX. This suggests that standar d imaging assessments of pancreatic carcinoma response to chemotherapy and radiation therapy may be inaccurate. CONCLUSIONS. Preresectional delivery of chemotherapeutic agents with RT allows response rates to b e quantified histologically. This method of response analysis, being m uch more sensitive than analysis by computed tomographic scanning, may allow the more rapid development of improved chemotherapeutic program s for this malignancy. (C) 1996 American Cancer Society.