Role of Radiation Therapy in Patients With Resectable Pancreatic Cancer

The 5-year overall survival of patients with pancreatic cancer is approximately 5%, with potentially resectable disease representing the curable minority. Although surgical resection remains the cornerstone of treatment, local and distant failure rates are high after complete resection, and debate continues as to the appropriate adjuvant therapy. Many oncologists advocate for adjuvant chemotherapy alone, given that high rates of systemic metastases are the primary cause of patient mortality. Others, however, view locoregional failure as a significant contributor to morbidity and mortality, thereby justifying the use of adjuvant chemoradiation. As in other gastrointestinal malignancies, neoadjuvant chemoradiotherapy offers potential advantages in resectable patients, and clinical investigation of this approach has shown promising results; however, phase III data are lacking. Further therapeutic advances and prospective trials are needed to better define the optimal role of adjuvant and neoadjuvant treatment in patients with resectable pancreatic cancer.

Introduction

Pancreatic cancer is the fourth leading cause of cancer-related death in the United States and accounts for roughly 40,000 deaths each year.[1] Patients generally present with locally advanced or metastatic disease that precludes cure, since symptoms frequently prompt the diagnosis in the absence of effective screening strategies. Even among patients who present with localized disease, the 5-year overall survival (OS) is approximately 20%, but potentially higher in patients with complete surgical resection (R0) and uninvolved lymph nodes.[2,3] Local and/or distant recurrence is common following resection, highlighting the importance of adjuvant therapy.[4,5] Despite the use of neoadjuvant and adjuvant therapies, little progress has been made in the last three decades, and the search for more efficacious treatment continues.[6] In this article, we review the data surrounding the use of chemotherapy (CT) and chemoradiotherapy (CRT) in patients with resectable pancreatic cancer.

Early Adjuvant Therapy Trials

The 1985 GITSG trial

TABLE 1

Randomized Trials of Adjuvant Therapy in Patients With Resected Pancreatic Cancer

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