Adjuvant chemotherapy in pancreatic cancer

There is increasing interest in the use of adjuvant treatment for pancreatic cancer since although postoperative mortality is much improved, median long-term survival is only on the order of 11-15 mo. Despite a proliferation of studies in advanced pancreatic cancer indicating a benefit for chemotherapy, there has only been one small randomized adjuvant trial. A combination of 5-fluorouracil, doxorubicin, and mitomycin-C demonstrated a significantly improved median survival (23 vs 11 mo in controls) but no significant improvement in 5-yr survival (4 vs 8%, respectively). At present there is insufficient evidence to support the routine use of adjuvant chemotherapy (even with radiotherapy) outside of controlled trials. What is required is large randomized trials of adjuvant chemotherapy. A further important question that needs addressing is the role of adjuvant radiotherapy (with concomitant chemotherapy) with or without sequential chemotherapy.