ADJUVANT RADIOTHERAPY AND FOLLOW-ON CHEMOTHERAPY IN PATIENTS WITH PANCREATIC-CANCER - RESULTS OF THE UK PANCREATIC-CANCER GROUP-STUDY (UKPACA-1)

Background: The role of adjuvant measurement for pancreatic cancer is uncertain. The Gastrointestinal Tumour Study Group (GITSG) showed that the survival in 21 patients randomised to radiochemotherapy (40Gy wit h 5-fluorouracil-5FU) followed by two years weekly 5FU was doubled at two years compared to the 22 patients with resection alone (43% vs 18% respectively). Methods: The GITSG protocol was repeated in 34 patient s with pancreatic cancer and six patients with stage III/IV ampullary cancer. Results: The two-year survival rate in the 34 patients with pa ncreatic adenocarcinoma was 38%, with a five year survival rate of 15% and a median survival of 13.2 months, The two year survival rate was significantly greater in patients with negative lymph nodes compared t o those with involved lymph nodes (63% vs 17% respectively; p = 0.008) , Similar results were found in the six patients with Stage III/IV per iampullary cancer. One (3%) of 39 patients who had radiotherapy suffer ed significant toxicity and four (14%) of 29 patients who were able to commence weekly chemotherapy also had major toxicity, with low grade toxicity being common, Conclusions: Although this study suggested a be nefit for adjuvant treatment using the GITSG protocol, the survival ra tes were consistent also with the results of several other studies whi ch did not use adjuvant therapy. Radiotherapy and chemotherapy were to lerated reasonably well in the majority of patients following major pa ncreatic resection, The role of adjuvant treatment can only be address ed adequately by large randomized studies.