Neoadjuvant, adjuvant, and palliative treatment of pancreatic cancer.
Pancreatic cancer remains a highly malignant disease. Curative treatment is only possible for patients diagnosed at a very early stage. Therefore, the vast majority of pancreatic cancer patients receive palliative treatment. Surgical palliation is offered to patients who are found not to have a resectable tumor. The treatment of obstructive jaundice is managed by stenting of the common bile duct or by a surgical bypass. The best possible surgical procedure should be based on the factors that influence hospital mortality, length of survival, and quality of life. In patients with a life expectancy of longer than 3 months, surgical bypass is recommended, with hepaticojejunostomy the treatment of choice. In the same surgical procedure, the relief of duodenal obstruction with a gastroenteric bypass should be achieved. Chemotherapy, radiotherapy, or a combination of both is employed as a neoadjuvant measure, as an adjuvant treatment, or, in most patients, as palliation. As palliative chemotherapy alone, 5-fluorouracil (5-FU) plus folinic acid is still the treatment of choice; however, newer drugs, such as gemcitabine, seem to have similar or marginally better results. Palliative radiochemotherapy with external-beam radiation plus 5-FU and folinic acid seems to lead to better local control of tumor progression but not to better survival, for which distant metastases are the limiting factor.
Birk
D
D
Department of General Surgery, University of Ulm, Steinhoevelstrasse 9, 89075 Ulm, Germany.
Beger
H G
HG
D017024:Chemotherapy, Adjuvant; D005060:Europe / Q000453:epidemiology; D006801:Humans; D020360:Neoadjuvant Therapy; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000628:therapy*; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D014481:United States / Q000453:epidemiology