Adjuvant chemoradiotherapy in pancreatic adenocarcinoma

Although patients undergoing complete resection for pancreatic adenocarcinoma have been known to carry a poor prognosis due to recurrent disease, experience with combined chemoradiotherapy is relatively sparse. This is due to the fact that this situation is sufficiently rare and a single institution is unable to obtain a significant number of patients for such a study. The only major randomized study comes from the Gastrointestinal Tumor Study Group (GITSG) who showed that median survival following relatively mild chemoradiotherapy (40 Gy in a split course with 5FU 500 mg/m2 on the first three days of each 20 Gy) showed an advantage over radical surgery alone of twenty months versus eleven months (p = 0.03). The GITSG continued to register patients for the treatment arm and the median survival of this group was comparable to that of the untreated patients. In other experience, the results from Tokyo reported a three year survival of fifty-seven percent with intraoperative irradiation and hepatic arterial or portal Mitomycin C. The results from the University of Pennsylvania showed a fifty-nine percent two year survival with patients receiving 45 to 48.6 Gy and infusion 5FU.