Preoperative chemoradiation for pancreatic cancer

Evaluation of the potential value of chemotherapy and radiation therapy in improving local disease control and survival of patients with pancreatic cancer requires accurate pretreatment staging to define the study population and a standardized system for pathologic evaluation of surgical specimens to determine the completeness of resection. These critical steps are rarely taken in pancreatic cancer studies, which leads to a heterogeneous patient population and renders interpretation of the published literature difficult. Single-institution experiences suggest that local failure rates are lower when either preoperative or postoperative chemoradiation is combined with surgery for the treatment of pancreatic cancer. Yet, clinical trials concerning the advantages of preoperative or postoperative chemoradiotherapy have yielded mixed results. Clinical trials involving patients with localized pancreatic cancer are needed that use accurate, reproducible pretreatment staging techniques, and standardized pathologic evaluation of surgical specimens.