Adjuvant therapy in pancreatic cancer

The outlook for patients with pancreatic cancer has been grim. There have b een major advances in the surgical treatment of pancreatic cancer, leading to a dramatic reduction in post-operative mortality from the development of high volume specialized centres. This stimulated the study of adjuvant and neoadjuvant treatments in pancreatic cancer including chemoradiotherapy an d chemotherapy. Initial protocols have been based on the original but rathe r small GITSG study first reported in 1985. There have been two large Europ ean trials totalling over 600 patients (EORTC and ESPAC-1) that do not supp ort the use of chemoradiation as adjuvant therapy. A second major finding f rom the ESPAC-1 trial (541 patients randomized) was some but not conclusive evidence for a survival benefit associated with chemotherapy.. A third maj or finding from the ESPAC-1 trial was that the quality of life was not affe cted by the use of adjuvant treatments compared to surgery alone. The ESPAC -3 trial aims to assess the definitive use of adjuvant chemotherapy in a ra ndomized controlled trial of 990 patients.