Adjuvant chemoradiation therapy for pancreatic cancer

Abstract

Despite newer treatment modalities, overall outcome for pancreatic cancerremains poor and has changed very little during the past 30 years. Surgeryremains the mainstay, but delivery of adjuvant postoperative therapy has beenshown to be essential for long-term survival. Large, prospective randomizedstudies have revealed conflicting data on whether chemotherapy alone or combinationchemoradiation is optimal. They have also triggered debates regarding thesequencing of adjuvant therapy strategies. Unfortunately, marked discrepanciesexist with patient selection as well as trial design among these studies, resulting ininadequate comparisons of their conclusions. Nevertheless, like other gastrointestinalmalignancies, it appears that adjuvant combination chemoradiation issuperior to chemotherapy alone when the data is critically analyzed. This critical examination of the published data to date is provided in the forthcoming chapter, along with an assessment of what is needed for future trials to determine theoptimal adjuvant treatment modality and improve overall outcome for pancreaticcancer patients.