Combined-modality therapy in pancreatic cancer: Current status and future directions

The use of chemotherapy with concurrent radiation therapy remains a standar d treatment option for patients with unresectable or resected adenocarcinom a of the pancreas. This treatment strategy is based in large part on data f rom serial Gastrointestinal Tumor Study Group (GITSG) trials, which have in cluded 5-fluorouracil (5-FU). Unfortunately, the majority of patients conti nue to succumb to the disease process. Recently, there has been a resurgenc e in clinical trials investigating alternative combined modality treatment strategies for patients with pancreatic cancer. In this review, we will sum marize both the mature and more recent data pertaining to combined modality therapy for patients with unresectable or resected pancreatic cancer. Stra tegies utilizing concurrent gemcitabine, alternative radiation therapy tech niques, and/or altered sequencing of therapies will be highlighted. Such mo difications to the approach in use since the 1980s will need to be fully co nsidered as clinical trials utilizing chemoradiotherapy regimens and new sy stemic agents or novel targeted therapies are designed.