Adjuvant postoperative radiation therapy +/- 5-FU in resected carcinoma of the pancreas.

Ductal adenocarcinoma of the pancreas was the fourth leading cause of cancer related deaths in the United States in 1996. Pancreatic cancer is often considered a uniformly fatal disease due to its usually advanced stage at presentation. Only 5-25% of cases are resectable and surgery offers the only single modality hope of potential cure. In the past, even resectable tumors were considered incurable. Retrospective analyses of patterns of failure and prognostic variables following surgical resection, however, have resulted in randomized and non-randomized trials that have succeeded in doubling the median and long-term survival with the use of adjuvant postoperative chemoradiation. Subsequent analyzes of failure patterns following adjuvant treatment in patients with resected pancreas cancer have shown an improvement in local control, but the majority of patients continue to develop either liver and/or peritoneal metastases. To further improve survival in surgically resectable carcinoma of the pancreas, better systemic treatment and/or abdominal prophylaxis needs to be evaluated in controlled clinical trials.