Adjuvant and neoadjuvant radiochemotherapy in ductal pancreatic carcinoma.
BACKGROUND
Ductal pancreatic carcinoma ranks third among malignancies of the gastrointestinal tract and its incidence is rising. Today, patients with this disease still have fatal prognosis necessitating efforts towards more effective treatment.


METHODS
This report provides a review of adjuvant and neoadjuvant radiotherapy in pancreatic carcinoma without distant metastasis. Particular respect is given to prospective, randomized trials. They are analyzed according to clinical staging: 1. In resectable tumors adjuvant, neoadjuvant or intraoperative radiotherapy is performed. 2. Radiotherapy in neoadjuvant intention is an approach for downstaging to achieve resectability in initially irresectable tumors.


RESULTS
The widespread use of new techniques such as supervoltage irradiation, computer based 3-D-planning, interventional therapy and combination of different therapeutic modalities induced a great number of studies. When concomitant chemotherapy was added to radiotherapy, results became significantly better compared to exclusive radiotherapy. It is shown that patients with operable tumors will have better survival rates and lower risk of relapse, if radiochemotherapy is added to surgery. Patients with irresectable tumors possible can be downstaged and be brought to resection nevertheless.


CONCLUSIONS
Simultaneous radiochemotherapy with 5-FU and mitomycin C can be performed without elevated risk of acute side effects of higher degree. This approach may be indicated in the case of adjuvant situations in patients free of distant metastases. Neoadjuvant simultaneous radiochemotherapy should only be performed as a part of a clinical trial.
Brunner
T B
TB
Department of Radiation Therapy, Friedrich-Alexander-University Erlangen-Nürnberg, Germany. thomas.brunner@strahlen.imed.uni-erlangen.de
Grabenbauer
G G
GG
Baum
U
U
Hohenberger
W
W
Sauer
R
R
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D006801:Humans; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D011880:Radiotherapy Planning, Computer-Assisted