Adjuvant and neoadjuvant radiochemotherapy in ductal pancreatic carcinoma

Background: Ductal pancreatic carcinoma ranks third among malignancies of t he gastrointestinal tract and its incidence is rising. Today, patients with this disease still have fatal prognosis necessitating efforts towards more effective treatment. Material and Methods: This report provides a review of adjuvant and neoadju vant radiotherapy in pancreatic carcinoma without distant metastasis. Parti cular respect is given to prospective, randomized trials. They are analyzed according to clinical staging: 1. In resectable tumors adjuvant, neoadjuva nt or intraoperative radiotherapy is performed. 2. Radiotherapy in neoadjuv ant intention is an approach for downstaging to achieve resectability in in itially irresectable tumors. Results: The widespread use of new techniques such as supervoltage irradiat ion, computer based 3-D-planning, interventional therapy and combination of different therapeutic modalities induced a great number of studies. When c oncomitant chemotherapy was added to radiotherapy, results became significa ntly better compared to exclusive radiotherapy. It is shown that patients w ith operable tumors will have better survival rates and lower risk of relap se, if radiochemotherapy is added to surgery. Patients with irresectable tu mors possibly can be downstaged and be brought to resection nevertheless. Conclusions: Simultaneous radiochemotherapy with 5-FU and mitomycin C can b e performed without elevated risk of acute side effects of higher degree. T his approach may be indicated in the case of adjuvant situations in patient s free of distant metastases. Neoadjuvant simultaneous radiochemotherapy sh ould only be performed as a part of a clinical trial.