Adjuvant therapy for pancreas cancer: advances and controversies

Although the benefit of adjuvant therapy for pancreas cancer is clear, the most effective therapy remains elusive. In the United States, combination therapy with chemotherapy and radiation remains the standard of care, while in other parts of the world the contribution of radiation is questioned. Clinical trials are reported evaluating the benefit of post-resection radiation and chemotherapy with 5-fluoruoracil (5FU), gemcitabine, and combination therapy; chemotherapy alone with either 5FU or gemcitabine; and pre-resection chemotherapy and radiation. Attention to pancreas cancer staging, radiation techniques, and clinical trial design are paramount to interpreting the outcomes from adjuvant therapy. Therapeutic advances will be made with new approaches studied in carefully controlled trials.