Adjuvant or Neoadjuvant Therapy for Pancreatic Carcinoma?

Abstract

Whipple’s resection for pancreatic cancer is an inadequate procedure and should be regarded as a lumpectomy. Adjuvant treatment should be directed towards local regional and liver recurrences. In the USA, adjuvant treatment after curative Whipple resection is standard procedure, based upon results of the GITSG study in which postoperative radiotherapy and 5-FU treatment resulted in significantly better survival in 23 patients. Preliminary results of our study in Rotterdam, however, do not seem to confirm these data. In this study, 218 patients were randomly assigned to surgery only or for 40-Gy radiotherapy and 4 weeks 5-FU treatment. Another option is neoadjuvant treatment which has theoretic advantages. A number of nonrandomized studies seem to indicate that radiotherapy and 5-FU treatment may have benefit in pancreatic cancer in a neoadjuvant treatment form. It is not clear which direction to take. Randomized studies are necessary to study the effect of neoadjuvant treatment with radiotherapy and 5-FU or with regional perfusion of the pancreatic area.

Heparanase expression is a prognostic indicator for postoperative survival in pancreatic adenocarcinoma

“…There is no established adjuvant therapy after successfull operation despite the fact that the disease frequently relapses. Palliative treatments apart from best supportive care offer only marginal improvements in quality of life and survival, if any (Ahlgren, 1996;Burris et al, 1997;Jeekel, 1997). Therefore, it would be helpful to identify patients that might benefit from adjuvant therapy.…”

“…Adjuvant combination therapy may offer a small survival advantage but is associated with treatment related morbidity. It therefore is not unequivocally accepted (Kalser and Ellenberg, 1985;Ahlgren, 1996;Jeekel, 1997;Klinkenbijl et al, 1999). The cytotoxic agent gemcitabine is the only drug currently known to be effective for palliation.…”

Epidermal growth factor receptor blockade by antibody IMC-C225 inhibits growth of a human pancreatic carcinoma xenograft in nude mice

“…Treatment options for pancreatic carcinoma patients with advanced metastatic disease are limited because testing with virtually all approved chemotherapy drugs has been disappointing. Radiotherapy and 5‐fluorouracil (5‐FU) treatment can decrease locoregional tumor recurrence, but survival remains low because of widespread metastatic disease 2. More recently, gemcitabine has been reported to have an improved clinical benefit compared with 5‐FU (median survival, 5.7 months compared with 4.4 months) and demonstrated improved relief of symptoms but with a low objective response rate 3, 4.…”

Standard Kausch-Whipple Pancreatoduodenectomy

“…The increasing interest in adjuvant treatment [62, 63, 64, 65]also requires a more inherent understanding of the operations being undertaken. The European Study Group for Pancreatic Cancer (ESPAC) is currently undertaking an adjuvant study comparing radiochemotherapy or chemotherapy or a combination of both with no treatment [65].…”