The evolving role of postoperative adjuvant radiation therapy for pancreatic cancer.
The benefit of postoperative adjuvant chemoradiation in the treatment of resected pancreatic cancers was first established by a randomized trial conducted by the Gastrointestinal Tumor Study Group in 1974. During the past 3 decades, treatment has evolved toward more dose-intensive regimens of chemoradiation. Historical split-course conventional radiation therapy has been replaced by continuous-course radiotherapy to higher doses, and gemcitabine is being actively investigated as a potentially more effective agent than 5-fluorouracil. This article critically examines the results of important randomized multi-institutional trials and reviews the evolution toward dose-intensive adjuvant treatment regimens. Implications of the recently completed intergroup study are discussed, modern radiation therapy delivery techniques are reviewed, and suggestions for future trials are made.
Garofalo
Michael C
MC
Department of Radiation Oncology, University of Maryland at Baltimore, 22 South Green Street, Baltimore, MD 21201, USA. mgarofalo@umm.edu
Kwok
Young
Y
Regine
William F
WF
D000230:Adenocarcinoma / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D017326:Clinical Trials, Phase III as Topic; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D011379:Prognosis; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States