Preoperative chemoradiotherapy for localized pancreatic carcinoma. A perspective.
BACKGROUND
The role of chemotherapy (CTX) in the treatment of localized adenocarcinoma of the pancreas must be enhanced if current results are to be surpassed. It is postulated that histologic response to various chemotherapeutic agents may offer an assessable endpoint intermediate to and perhaps as or more meaningful than survival analysis.


METHODS
A history of trials assessing the value of adjuvant preoperative and postoperative chemotherapy and radiation therapy (RT) is provided. Experiences with histologic assessment of treatment response are reviewed.


RESULTS
There has been no clear benefit from adjuvant CTX, either when delivered with RT or as postoperative maintenance. Imaging tests were much less sensitive than histologic grading in determining responses (7% vs. 71% partial responses) of patients with resected pancreatic cancers previously treated with RT/CTX. This suggests that standard imaging assessments of pancreatic carcinoma response to chemotherapy and radiation therapy may be inaccurate.


CONCLUSIONS
Preresectional delivery of chemotherapeutic agents with RT allows response rates to be quantified histologically. This method of response analysis, being much more sensitive than analysis by computed tomographic scanning, may allow the more rapid development of improved chemotherapeutic programs for this malignancy.
Hoffman
J P
JP
Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA.
O'Dwyer
P
P
Agarwal
P
P
Salazar
H
H
Ahmad
N
N
D000230:Adenocarcinoma / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D010190:Pancreatic Neoplasms / Q000628:therapy*; D011300:Preoperative Care; D018714:Radiotherapy, Adjuvant