ADJUVANT CHEMOTHERAPY IN PANCREATIC-CANCER

There is increasing interest in the use of adjuvant treatment for panc reatic cancer since although postoperative mortality is much improved, median long-term survival is only on the order of 11-15 mo. Despite a proliferation of studies in advanced pancreatic cancer indicating a b enefit for chemotherapy, there has only been one small randomized adju vant trial. A combination of 5-fluorouracil, doxorubicin, and mitomyci n-C demonstrated a significantly improved median survival (23 vs 11 mo in controls) but no significant improvement in 5-yr survival (4 vs 8% , respectively). At present there is insufficient evidence to support the routine use of adjuvant chemotherapy (even with radiotherapy) outs ide of controlled trials. What is required is large randomized trials of adjuvant chemotherapy. A further important question that needs addr essing is the role of adjuvant radiotherapy (with concomitant chemothe rapy) with or without sequential chemotherapy.