[Primary and adjuvant radiochemotherapy of pancreatic carcinoma]

Pancreatic carcinoma is a type of cancer with an extremely poor prognosis. Surgery is the only curative option, and only possible in a minority of patients. After surgery the 5-year survival rate is approximately 25%. The role of radiochemotherapy in the treatment of locally advanced pancreatic cancer and in the adjuvant setting is discussed:--Locally advanced disease: Numerous studies are being performed to improve disease free survival in locally advanced disease. So far the combination of high dose radiotherapy and continuous infusion of 5-fluorouracil appears to be the best option. However, the potential gain is limited, and this should be weighed against the burden of treatment for patients with a very short life expectancy. New combinations are being investigated.--Adjuvant treatment: After radical surgery there is no standard adjuvant treatment. Four randomized trials were performed so far. In one of these only the role of chemotherapy was investigated. In the three other trials the radiochemotherapy applied was not optimal. Yet a trend for a survival benefit was seen in two of these trials, at least in the subgroup of pancreatic head cancer. One of the four trials appears to show a benefit from chemotherapy. These results warrant further investigation of the role of (optimal) radiochemotherapy, and the role of chemotherapy. In collaboration with the FFCD and GERCOR, the EORTC will start an international multicenter randomized phase III study comparing high dose radiotherapy and concomitant continuous infusion of 5-FU versus control after pancreatico-duodenectomy for pancreatic head cancer (22995/40992).