[Radiotherapy and chemotherapy for unresectable pancreatic cancer]

Despite many advances in the diagnosis of pancreatic cancer (PC), only a small minority of patients are candidates for surgical resection with curative intent. Moreover, even for these selected patients, the prognosis remains unfavorable because of postoperative recurrence. Accordingly, to improve the prognosis of PC, there is an urgent need to develop effective non-surgical treatments for this disease. Radiotherapy (RT) alone does not have a significant clinical impact in PC, but when combined with chemotherapy (CHT), it provides a survival benefit in locally unresectable PC. However, to establish optimal methods of combining RT with CHT, newer approaches such as specialized RT techniques and new CHT agents are actively being pursued. At present CHT for PC has only limited value in clinical practice due to the lack of any individual agent with a truly high level of activity. The strategies for effective CHT in PC include biochemical modulation of anticancer agents, multi-agent CHT, and new agents with different mechanisms of action. Among these strategies, the identification of more effective new agents is a high priority in developing a truly effective CHT for PC. The novel nucleoside analog gemcitabine has the potential to produce better results than those achieved with 5-FU, and has been accepted as first-line CHT for patients with advanced PC. Moreover, increased understanding of the biology of PC should facilitate the development of entirely novel treatment options. We must continue to actively search for more effective non-surgical treatments for PC.