[Pancreatic carcinoma. Optimizing therapy by adjuvant and neoadjuvant therapy?]

Increasing resection rates for pancreatic tumors and decreasing postoperative mortality rates in specialised centres let arise the question of an additional benefit of adjuvant therapy. Despite of extended and radical surgery the recurrence rates after resection of pancreatic cancer remain high. Several studies have indicated some chemo- and radiosensitivity of these tumors. Whether a (combination-)chemotherapy alone or a combined radiochemotherapy should be recommended can actually not be answered yet. However, adjuvant radiotherapy alone seems to be inferior to combined radiochemotherapy. Intraoperative radiotherapy as well as preoperative radiotherapy are not superior to postoperative percutaneous radiotherapy regarding recurrence rate and survival. Preoperative radiotherapy, preferably in combination with chemotherapy, should be considered in patients with non resectable or borderline resectable pancreatic tumors with the aim of downstaging and secondary resection. The preliminary results of regional adjuvant chemotherapy are impressing, but need to be confirmed in further, randomised studies. Overall, the availability of a good or even optimal adjuvant therapy for pancreatic cancer still seems to be far away. Therefore, all surgeons need to be encouraged to include their patients with resected pancreatic carcinoma in a current study protocol of adjuvant treatment, since only tenacious and multicentric research can lead to progress in this severe disease.