Controversies and consensus of the adjuvant therapy of pancreatic cancer / 中国癌症杂志

ABSTRACT

Pancreatic cancer is a highly malignant neoplasm with dismal prognosis. The risk of recurrence and metastasis remains high even for patients who have undergone radical dissection. Therefore, adjuvant therapy after "curative" resection is crucial. However, consensus on the optimal management of pancreatic cancer after surgery has not been reached. Both chemotherapy and concurrent chemoradiation therapy have been advocated. Yet, based upon the results of published phase Ⅲ trials, the consensus and standard strategy of adjuvant treatment after pancreatic cancer surgery is still undo" debate. According to the results of GITSG and RTOG trials, the mainstream in North American is adjuvant chemoradiation. However, based on the results of ESPAC-1 and CONKO-001 studies, the oncologists in Europe usually recommend chemotherapy alone. Furthermore, the superiority of gemcitabine over 5-FU in the adjuvant setting is largely unclear. This article reviewed the main results of the clinical trials in the field of adjuvant treatment of pancreatic cancer.From the authors' view, both the standard dosage of gemcitabine (CONCO-001) and chemoradiation (RTOG-9704) after resection of pancreatic cancer could be considered as candidates for adjuvant strategy. However, the optimal therapy will have to be determined by trials with larger number of patients.