CURRENT APPROACHES TO MULTIMODALITY MANAGEMENT OF ADVANCED PANCREATIC-CANCER

For patients with localized pancreatic adenocarcinoma, the combination of radiation therapy and 5-fluorouracil has been shown to enhance pat ient survival. Following pancreatectomy, results in a second group of patients confirmed the benefit of 40 Gy of radiation administered as a split course, combined with 5-fluorouracil during and following the r adiation therapy, as noted in the original randomized study of the Gas trointestinal Tumor Study Group. When the disease is locally unresecta ble, 60 Gy of radiation administered in a double split regimen, in com bination with 5-fluorouracil, has significantly prolonged survival. Sp lit courses of radiation therapy seem better tolerated, allowing a gre ater proportion of patients to complete this phase of treatment. Hyper fractionation, heavy ion irradiation and intraoperative radiation ther apy have not been found to be more beneficial. Newer approaches includ e continuous intravenous or intraarterial infusion of the 5-fluorourac il, addition of mitomycin C or cisplatin. The results of neoadjuvant t rials of radiation and chemotherapy are not sufficiently mature to det ermine their effect on patient survival. Neoadjuvant therapy has not b een subjected to testing in randomized trials. Chemotherapy will conti nue to offer very limited benefit for patients with advanced metastati c disease until more effective drugs can be developed. Innovative appr oaches utilizing growth factors and photodynamic therapy should be stu died in carefully monitored fashion.