Adjuvant chemoradiotherapy in pancreatic adenocarcinoma

Although patients undergoing complete resection for pancreatic adenocarcinoma have been known to carry a poor prognosis due to recurrent disease, experience with combined chemoradiotherapy is relatively sparse. This is due to the fact that this situation is sufficiently rare and a single institution is unable to obtain a significant number of patients for such a study. The only major randomized study comes from the Gastrointestinal Tumor Study Group (GITSG) who showed that median survival following relatively mild chemoradiotherapy (40 Gy in a split course with 5FU 500 mg/m2 on the first three days of each 20 Gy) showed an advantage over radical surgery alone of twenty months versus eleven months (p=0.03). The GITSG continued to register patients for the treatment arm and the median survival of this group was comparable to that; of the untreated patients. In other experience, the results from Tokyo reported a three year survival of fifty-seven percent with intraoperative irradiation and hepatic arterial or portal Mitomycin C. The results from the University of Pennsylvania showed a fifty-nine percent two year survival with patients receiving 45 to 48.6 Gy and infusion 5FU.