Neoadjuvant and adjuvant strategies for chemoradiation

There is an increasing body of evidence showing that patients with resectable pancreatic cancer might benefit from adjuvant therapy. Based on phase III trials, potential options for adjuvant treatment are chemotherapy alone or a multimodal approach involving radiotherapy. Available data are heterogeneous and have been discussed controversially. Hitherto, a worldwide standard of care has not yet been established. Adequate patient selection might be the key element for a tailored adjuvant treatment. Clinical research currently focusses on gemcitabine alone or in combination, and some molecular biologic approaches with epidermal growth factor receptor monoclonal antibodies (EGFR-MoABs) and anti-angiogenic drugs. Recent advances in radiooncology offer better dose conformality and reduced morbidities. Currently, the co-operative Radiotherapy and Gastrointestinal Groups have launched a multicentric European Organization for Research and Treatment of Cancer (EORTC) trial investigating the impact of radiotherapy in combination with gemcitabine in R0-resected pancreatic head cancer.