[Adjuvant treatment of pancreatic cancer]

The prognosis of pancreatic cancer is poor at any stage. The complete resection of the tumour offers the only chance of cure, but 10-25 % of the patients at most present with operable disease, and median survival following surgery with curative intention is 18 months. Local recurrence is often accompanied or rapidly followed by distant metastasis. Studies of postoperative (adjuvant) treatment have yielded contradictory results. Combined radiochemotherapy resulted in improved survival in a few studies while others failed to demonstrate any survival benefit. Intraoperative radiation therapy given in addition to percutaneous irradiation may improve local tumour control at best. At present only few data support the benefit of adjuvant systemic chemotherapy alone. Unfortunately, the recently completed ESPAC-1 study was not very helpful in settling this issue due to its problematic design. Therefore, the results of ongoing studies of adjuvant chemotherapy are eagerly awaited. These studies have also included arms with gemcitabine, the current standard for palliative treatment of pancreatic cancer, and will hopefully allow firm conclusions as to the role of postoperative chemotherapy.