Background: Pancreatic cancer is the fifth leading cause of cancer-related death worldwide. Among patients treated with surgery alone, liver metastasis occurs in up to 50%, peritoneal recurrence in 25%, and local recurrence occurs in 50–80% of all patients who underwent resection. Even after a macroscopically curative resection, tumour cells might be observed by microscopy at one or more edges of the resected specimen in 20–51% (R-1) which might account for the high local recurrence. Aim of the Study: An analysis was performed in 54 patients who underwent an irradical resection (R-1 and R-2) for pancreatic cancer. 33 patients were treated with chemoradiotherapy. To evaluate the effect of therapy on survival and recurrence, this group was retrospectively compared to a group of 21 patients that did not receive chemoradiotherapy. Methods: Radiotherapy consisted of 50 Gy external upper abdomen radiation in two courses of 3 weeks, concomitant with intravenous 5-FU 25 mg/kg/24 h continuously on the first 4 days of each treatment course. Follow-up was performed mainly by CT scanning and occasionally by US and was completed for all but 1 patient. Results: The treatment protocol was completed in all patients without complications. Local recurrence was found in 6 (18%) patients in the group of patients who received adjuvant therapy versus 16 (48%) patients in the group that did not receive adjuvant therapy (p = 0.001). The median survival time for the treated group was 12.8 vs. 13.7 months in the group that did not receive chemoradiotherapy (p = 0.9). Three (9%) patients are still alive 140, 88 and 70 months after receiving surgery and adjuvant treatment. Conclusion: Adjuvant chemoradiotherapy clearly gives a significant better local control. However, treatment with 5-FU and radiotherapy does not improve survival due to distant metastases. This therapy probably prolongs survival in only a few patients. More effective treatment methods have to be designed to prevent metastatic disease and improve survival.

1.
Greenlee RT, Hill-Harmon MB, Murray T, Thun M: Cancer statistics, 2001. CA Cancer J Clin 2001;51:15–36.
2.
Evans DB, Abbruzzese JL, Willet CG: Cancer of the pancreas; in DeVita VT, Hellman S, Rosenberg SA (eds): Cancer, Principles and Practice of Oncology, ed 6. Lippincott, Williams & Wilkins, 2001, pp 1126–1161.
3.
Klinkenbijl JH, et al: Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 1999;230:776–782.
4.
Neoptolemos JP, et al: Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet 2001;358:1576–585.
5.
Neoptolemos JP, et al: Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial. Ann Surg 2001;234:758–768.
6.
Neoptolemos JP, et al: A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004;350:1200–1210.
7.
Wayne JD, et al: Localized adenocarcinoma of the pancreas: the rationale for preoperative chemoradiation. Oncologist 2002;7:34–45.
8.
Gastrointestinal Tumor Study Group: Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Cancer 19087;59:2006–2010.
9.
Sohn TA, et al: Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 2000;4:567–579.
10.
Pisters PW, et al: Rapid-fractionation preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for resectable pancreatic adenocarcinoma. J Clin Oncol 1998;16:3843–3850.
11.
Bajetta E, et al: Chemoradiotherapy as preoperative treatment in locally advanced unresectable pancreatic cancer patients: results of a feasibility study. Int J Radiat Oncol Biol Phys 1999;45:285–289.
12.
Boz G, et al: Radiotherapy and continuous infusion 5-fluorouracil in patients with nonresectable pancreatic carcinoma. Int J Radiat Oncol Biol Phys 2001;51:736–740.
13.
Fisher BJ, et al: Analysis of the clinical benefit of 5-fluorouracil and radiation treatment in locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 1999;45:291–295.
14.
Hoffman JP, et al: Phase II trial of preoperative radiation therapy and chemotherapy for patients with localized, resectable adenocarcinoma of the pancreas: an Eastern Cooperative Oncology Group Study. J Clin Oncol 1998;16:317–323.
15.
Ishii H, et al: Protracted 5-fluorouracil infusion with concurrent radiotherapy as a treatment for locally advanced pancreatic carcinoma. Cancer 1997;79:1516–1520.
16.
Jeekel J, Treurniet-Donker AD: Treatment perspectives in locally advanced unresectable pancreatic cancer. Br J Surg 1991;78:1332–1334.
17.
Mehta VK, et al: Protracted venous infusion 5-fluorouracil with concomitant radiotherapy compared with bolus 5-fluorouracil for unresectable pancreatic cancer. Am J Clin Oncol 2001;24:155–159.
18.
White R, et al: Preoperative chemoradiation for patients with locally advanced adenocarcinoma of the pancreas. Ann Surg Oncol 1999;6:38–45.
19.
Neoptolemos JP, Baker P, Johnson CD: Adjuvant radiotherapy and follow-on chemotherapy in patients with pancreatic cancer. Results of the UK Pancreatic Cancer Group Study (UKPACA-1). Gastrointestinal Cancer 1998;2:235–245.
20.
Willett CG, Lewandrowski K, Warshaw AL, Efird J, Compton CC: Resection margins in carcinoma of the head of the pancreas. Implications for radiation therapy. Ann Surg 1993;217:144–148.
21.
Treurniet-Donker AD, van Mierlo MJ, van Putten WL: Localized unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 1990;18:59–62.
22.
Gastrointestinal Tumor Study Group: Treatment of locally unresectable carcinoma of the pancreas: comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone. J Natl Cancer Inst 1988;80:751–755.
23.
Parker SL, Tong T, Bolden S, Wingo PA: Cancer statistics, 1997. CA Cancer J Clin 1997;47:5–27.
24.
Sperti C, Pasquali C, Piccoli A, Pedrazzoli S: Recurrence after resection for ductal adenocarcinoma of the pancreas. World J Surg 1997;21:195–200.
25.
Geer RJ, Brennan MF: Prognostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg 1993;165:68–72.
26.
Link KH, et al: Resection and radiochemotherapy of pancreatic cancer – the future? Langenbecks Arch Surg 1998;383:134–144.
27.
Ozaki H, Kinoshita T, Kosuge T, Egawa S, Kishi K: Effectiveness of multimodality treatment for resectable pancreatic cancer. Int J Pancreatol 1990;7:195–200.
28.
Ozaki H: Modern surgical treatment of pancreatic cancer. Int J Pancreatol 1994;16:121–129.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.