Radiotherapy in the adjuvant management of pancreatic adenocarcinoma.
There is sound rationale for the use of radiotherapy (RT) as part of adjuvant treatment in patients with resectable pancreatic adenocarcinoma. Most available data from randomized clinical trials and large reported experiences with RT indicate that chemoradiotherapy (chemoRT) improves outcome over surgery alone in this setting. The recent European Study Group for Pancreatic Cancer ESPAC-1 trial found, to the contrary, that chemoRT (when not accompanied by chemotherapy alone) was associated with poorer survival than surgery alone in patients with pancreatic adenocarcinoma. A number of objections regarding design of this trial have been noted, and it should be appreciated that survival with surgery alone in this trial was markedly longer than survival in other trials of adjuvant chemoradiotherapy in this setting. On balance, it is likely that optimal adjuvant therapy for pancreatic adenocarcinoma requires both radiotherapy and chemotherapy.
Abrams
Ross A
RA
Department of Radiation Oncology, Rush University Medical Center, Chicago, IL 60612, USA. Ross_a_abrams@rush.edu
D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic