The role of adjuvant therapy for pancreatic cancer.
OBJECTIVE
In spite of radical pancreatectomy with lymphadenectomy for adenocarcinoma of the pancreas, survival remains poor. We add two forms of adjuvant therapy, i.e., intraoperative radiotherapy and liver perfusion chemotherapy, to the radical resection. The aim of this study is to investigate the utility of these two forms of adjuvant therapy prospectively and to review their effectiveness.


METHODS
One hundred and ninety-six patients with pancreatic cancer who underwent radical pancreatectomy in our institute were enrolled. We conducted intraoperative radiation therapy 30 Gy against the retroperitoneal connective tissues around the superior mesenteric artery during surgery. Adjuvant liver perfusion chemotherapy was added immediately after operation via the portal vein using 5-fluorouracil (250 mg/body/day) for 3 to 4 weeks continuously. Overall survival analyses were done by the method of Kaplan and Meier.


RESULTS
Intraoperative radiation therapy did not influence the prognoses directly. However, the patients who received adjuvant liver perfusion chemotherapy had better prognoses (P < 0.05).


CONCLUSIONS
Although adjuvant therapy after radical resection with wide lymphadenectomy improves prognoses, the results are still not satisfactory. We should develop a new and more efficacious treatment.
Takeda
S
S
Department of Surgery II, Nagoya University School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya 466-8550, Japan. shinta@med.nagoya-u.ac.jp
Inoue
S
S
Kaneko
T
T
Harada
A
A
Nakao
A
A
D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis