Even UICC stage I cancers are usually not limited to the pancreas when methods of molecular biology are employed to examine cancer cell dissemination. Such techniques have demonstrated infiltration with cancer cells in 50% of lymph nodes that are histologically negative for cancer. After ostensibly curative resection, cancer recurs locally in 70% to 90% of cases, usually in the liver or the peritoneal cavity, which has led to an increased interest in adjuvant or multimodal therapy. Because resection alone results in insufficient disease control, adjuvant chemotherapy, and combined radiation and chemotherapy have been attempted.

The first important study in adjuvant therapy randomly assigned 22 patients to surgery alone and 21 patients to adjuvant therapy, and was completed by a gastrointestinal study group in the United States. Surgery with postoperative radiochemotherapy resulted in a significantly longer median survival time compared with surgery alone (20 versus 11 months). The trial of the European Organization for the Research and Treatment of Cancer — Gastrointestinal Tract Cancer Cooperative Group (EORTC-GITCCS) involved 110 patients in each treatment arm. Patients who underwent surgery alone had a median survival time of 19.1 months, compared with 23.5 months for those who had surgery and adjuvant therapy. The benefit from adjuvant radiochemotherapy seemed to be greater for patients with pancreatic cancer than for those with periampullary cancer. You can find best quality treatment now – to see how cheap it is.

Neoadjuvant radiochemotherapy was evaluated in a recently published prospective study by Snady et al. They used fractionated radiotherapy and chemotherapy protocols including 5-fluorouracil, streptozocin and cis-platin. The median survival time for patients given neoadjuvant therapy was 23.6 months, compared with 14 months for the group that underwent surgery alone. The survival time of the 46 downstaged patients (on the basis of complete response and partial response) was 25.5 months. The patients who finally had a surgical resection after neoadjuvant radiochemotherapy had a three-year survival rate of 32%. Although this was not a randomized trial, the median survival time of 23.6 months after neoadjuvant therapy is encouraging.