Chemotherapy, combined radiochemotherapy and new therapeutic approaches for adenocarcinoma of the pancreas

For patients having undergone complete resection for adenocarcinoma of the pancreas, combined radiochemotherapy protocols using bolus 5FU as neoadjuva nt or adjuvant treatments can help control disease spread and perhaps moder ately lengthen survival. As the rare controlled trials having tested these therapeutic strategies have provided conflicting data, this therapeutic att itude cannot be considered as a standard treatment. The tested protocols us ing combined radiochemotherapy were developed in the sixties and seventies and have been greatly improved since that time. New combinations for neoadj uvant and adjuvant radiochemotherapy protocols are currently under evaluati on in controlled therapeutic trials. Systemic chemotherapy (gemcitabin, 5FU, platinium) has a palliative effect, improving the quality of life in patients with advanced-stage disease. Gem citabin is easy to administer and has a low toxicity profile. It is widely used in standard protocols. Therapeutic trials combining gemcitabin and oth er cytotoxic agents are under way. Radiochemotherapy combinations using 5FU are a palliative alternative for patients with locally advanced disease, p articularly those with painful symptoms. There is an urgent need for more effective treatments against metastatic di sease and for better loco-regional management using a multidisiplinary appr oach. These patients should be treated within the framework of therapeutic trials.