Future role of radiotherapy as a component of treatment in biliopancreaticcancers

For resected and unresectable pancreas cancers, data will be summarized fro m both adjuvant and locally unresectable pancreas cancer series (EBRT +/- I OERT) to demonstrate the justification of continuing to utilize chemo-irrad iation as a component of treatment. The resultant improvements in local con trol with combined modality treatment, however, achieve only minimal improv ements in survival in view of the high incidence of abdominal relapse (live r and peritoneal). Further improvement in survival may necessitate regional approaches for chemotherapy or may await advances in gene therapy. For loc ally unresectable and resected but residual bile duct malignancies, chemoir radiation appears to enhance tumor control and survival. Dose intensificati on of both modalities may be useful in improving disease control and surviv al. After chemoirradiation, the addition of liver transplant, in carefully selected patients who are unresectable with standard resection, may further enhance disease control and survival over what would be expected with eith er approach in isolation.