[Chemotherapy, combined radiochemotherapy and new therapeutic approaches in adenocarcinoma of the pancreas].
For patients having undergone complete resection for adenocarcinoma of the pancreas, combined radiochemotherapy protocols using bolus 5FU as neoadjuvant or adjuvant treatments can help control disease spread and perhaps moderately lengthen survival. As the rare controlled trials having tested these therapeutic strategies have provided conflicting data, this therapeutic attitude cannot be considered as a standard treatment. The tested protocols using combined radiochemotherapy were developed in the sixties and seventies and have been greatly improved since that time. New combinations for neoadjuvant and adjuvant radiochemotherapy protocols are currently under evaluation in controlled therapeutic trials. Systemic chemotherapy (gemcitabine, 5FU, platinum) has a palliative effect, improving the quality of life in patients with advanced-stage disease. Gemcitabine is easy to administer and has a low toxicity profile. It is widely used in standard protocols. Therapeutic trials combining gemcitabine and other cytotoxic agents are under way. Radiochemotherapy combinations using 5FU are a palliative alternative for patients with locally advanced disease, particularly those with painful symptoms. There is an urgent need for more effective treatments against metastatic disease and for better loco-regional management using a multidisciplinary approach. These patients should be treated within the framework of therapeutic trials.
André
T
T
Service d'Oncologie Médicale, Hôpital Tenon, Paris. thierry.andre@tnn.ap-hop-paris.fr
Balosso
J
J
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D018849:Controlled Clinical Trials as Topic; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D015337:Multicenter Studies as Topic; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D011182:Postoperative Care; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D003841:Deoxycytidine; D002945:Cisplatin; D005472:Fluorouracil; D000093542:Gemcitabine