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.
Department of General Surgery, University of Ulm, Steinhoevelstrasse 9, 89075 Ulm, Germany.
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Beger
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