title: Advances in non-operative therapy in pancreatic cancer.
abstract: Pancreatic cancer is the fifth leading cause of cancer death in the western world. The majority of patients present with advanced disease and only a few have resectable disease at presentation. This paper reviews current evidence supporting the use of conventional chemotherapy and radiotherapy in advanced disease; it goes on to review the rationale and how these data have influenced the use of radiochemotherapy in the adjuvant setting. Unpublished data from the largest adjuvant study of chemoradiotherapy in pancreatic cancer are also presented. The role of neoadjuvant therapy is discussed and how trials using this approach are evolving in pancreatic cancer. The paper finishes by reviewing the use of marimastat, a novel agent that has been extensively studied in patients with pancreatic cancer. Pancreatic cancer remains a challenge to clinicians, but increases in sub-specialisation and a renewed interest in the disease has made the future for patients more encouraging than at any time in the past.
authors.affiliation: Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: R
authors.initials: R
authors.lastname: Brammer
authors.forename: J
authors.initials: J
authors.lastname: Buckels
authors.forename: S
authors.initials: S
authors.lastname: Bramhall
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006877:Hydroxamic Acids / Q000627:therapeutic use; D008297:Male; D008666:Metalloendopeptidases / Q000037:antagonists & inhibitors; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D004791:Enzyme Inhibitors; D006877:Hydroxamic Acids; D003841:Deoxycytidine; C100342:marimastat; D008666:Metalloendopeptidases; D002945:Cisplatin; D000093542:Gemcitabine