Nonoperative treatment for carcinoma of the pancreas

Carcinoma of the pancreas, presenting so often at an inoperable stage, has been the subject of many nonoperative therapeutic regimens. Radiotherapy using high-dose techniques has been shown to produce 45% palliation. The author discusses in detail radical techniques, with and without chemotherapy, that have resulted in a modest improvement in survival. But because a median survival time of little more than 1 year is achieved by even radical radiotherapy, investigational uses of radiation, both interstitial and intraoperative, are reviewed. As chemotherapy becomes more sophisticated and drug toxicity, interaction and synergism are better understood, previous response rates of 10%, to 15% are now reaching 30% to 45%. The latest results of multimodality therapy show some improvement over single modality treatment. The author presents a broad review of nonoperative techniques including discussion of current trends and future possibilities.