EVOLVING STRATEGIES FOR THE TREATMENT OF ADENOCARCINOMA OF THE PANCREAS - A REVIEW

Adenocarcinoma of the pancreas has an incidence of only 0.01%, yet is the fourth leading cause of cancer death for American men and women. D espite this dismal outlook, new strategies for staging and therapy for pancreatic cancer have emerged over the last few years. Laparoscopy w ith cytologic evaluation of peritoneal washings, and more recently, al though still investigational, endoscopic and intracorporeal ultrasonog raphy have provided more detailed staging information. The result of i mproved staging is earlier, more accurate selection of treatment most appropriate for stage of disease. For those patients with clinically l ocalized disease, laparotomy with an attempt at resection is indicated , particularly with the recent trend in declining morbidity and operat ive mortality associated with pancreatectomy. With clinically unresect able disease, patients may potentially be spared the morbidity of lapa rotomy. Advances in therapeutic endoscopic and percutaneous manipulati on of the obstructed biliary tree have provided an alternative to surg ery and improved quality of life for patients with abbreviated life sp ans. Gastroduodenal obstruction has traditionally been managed by lapa rotomy, although with improved technology and surgical skill, a laparo scopic approach may become standard. Because even at presentation panc reatic cancer is rarely a localized process but is a disseminated dise ase, surgery alone is unlikely to increase survival rates in the absen ce of adjuvant therapies. Present and future strategies for treatment include the addition of neoadjuvant regimens and adjuvant modalities i ncluding intraoperative radiation, photodynamic therapy, intraperitone al therapies, and pancreatic and splanchnic perfusion. Clearly, the gr eatest strides in treatment of pancreatic cancer will come with develo pment of new agents with significantly greater antitumor efficacy.