Adjuvant therapy for pancreatic cancer

Pancreatic cancer is a major cause of cancer death; and despite advances in the standards of surgery and supportive care, the median and long-term sur vival rates have not shown similar dramatic improvements. Techniques such a s radical surgery alone cannot guarantee a cure. Previous work with convent ional chemotherapy and radiotherapy in patients with advanced pancreatic ca ncer has indicated a role for adjuvant therapy for patients with resectable tumors. The main modalities that have been assessed are based on the Gastr ointestinal Tumour Study Group (GITSG) results using 5-fluorouracil chemoth erapy, external beam radiation therapy (EBRT), or both. Alternative approac hes such as neoadjuvant therapy have been used, which may increase the numb er of patients suitable for resection; and regional therapy techniques have been used to increase the therapeutic potential by concentrating agents to the tumor bed. The results of single or combination therapy do show some i mprovement in survival but have been limited in most cases to retrospective nonrandomized series of patients. Therefore the results must be assessed a s such. There are several large randomized trials that will deliver definit ive answers in the near future as to whether conventional adjuvant therapy is effective. New approaches using novel agents for advanced disease are cu rrently being assessed, and they may eventually identify the most appropria te and effective agents to use for pancreatic cancer in the adjuvant settin g.