Pancreatic tumors. Additional benefit of adjuvant and neoadjuvant therapy?

Increasing resection rates for pancreatic tumors and decreasing postoperati ve mortality rates in specialised centres let arise the question of an addi tional benefit of adjuvant therapy. Despite of extended and radical surgery the recurrence rates after resection of pancreatic cancer remain high. Sev eral studies have indicated some chemo- and radiosensitivity of these tumor s. Whether a (combination-)chemotherapy alone or a combined radiochemothera py should be recommended can actually not be answered yet. However, adjuvan t radiotherapy alone seems to be inferior to combined radiochemotherapy. In traoperative radiotherapy as well as preoperative radiotherapy are not supe rior to postoperative percutaneous radiotherapy regarding recurrence rate a nd survival. Preoperative radiotherapy, preferably in combination with chem otherapy, should be considered in patients with non resectable or borderlin e resectable pancreatic tumors with the aim of downstaging and secondary re section. The preliminary results of regional adjuvant chemotherapy are impr essing, but need to be confirmed in further, randomised studies. Overall, t he availability of a good or even optimal adjuvant therapy for pancreatic c ancer still seems to be far away. Therefore, all surgeons need to be encour aged to include their patients with resected pancreatic carcinoma in a curr ent study protocol of adjuvant treatment, since only tenacious and multicen tric research can lead to progress in this severe disease.