Seminars in Oncology
Volume 34, Issue 4 , Pages 321-326 , August 2007

Adjuvant Therapy for Pancreas Cancer: Advances and Controversies

  • Mary F. Mulcahy

      Affiliations

    • Corresponding Author InformationAddress correspondence to Mary F. Mulcahy, MD, Northwestern University Feinberg School of Medicine, Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, 676 North Saint Clair, Suite 850, Chicago, IL 60611.

References 

  1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2007. CA Cancer J Clin. 2007;57:43–66
  2. Kelsen DP, Portenoy R, Thaler H, et al. Pain as a predictor of outcome in patients with operable pancreatic carcinoma. Surgery. 1997;122:53–59
  3. AJCC Cancer Staging Manual. (ed 6). New York, NY: Springer-Verlag; 2002;
  4. Varadhachary GR, Tamm EP, Crane C, et al. Borderline resectable pancreatic cancer. Curr Treat Options Gastroenterol. 2005;8:377–384
  5. Saldinger PF, Reilly M, Reynolds K, et al. Is CT angiography sufficient for prediction of resectability of periampullary neoplasms?. J Gastrointest Surg. 2000;4:233–237
  6. Valls C, Andia E, Sanchez A, et al. Dual-phase helical CT of pancreatic adenocarcinoma: Assessment of resectability before surgery. AJR. 2002;178:821–826
  7. Sheridan MB, Ward J, Guthrie JA, et al. Dynamic contrast-enhanced MR imaging and dual-phase helical CT in the preoperative assessment of suspected pancreatic cancer: A comparative study with receiver operating characteristic analysis. AJR. 1999;173:583–590
  8. Wiersema MJ. Accuracy of endoscopic ultrasound in diagnosing and staging pancreatic carcinoma. Pancreatology. 2001;1:625–632
  9. Raut CP, Grau AM, Staerkel GA, et al. Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration in patients with presumed pancreatic cancer. J Gastrointest Surg. 2003;7:118–126
  10. Nishiyama Y, Yamamoto Y, Yokoe K, et al. Contribution of whole body FDG-PET to the detection of distant metastasis in pancreatic cancer. Ann Nucl Med. 2005;19:491–497
  11. Pietrabissa A, Caramella D, Di Candio G, et al. Laparoscopy and laparoscopic ultrasonography for staging pancreatic cancer: Critical appraisal. World J Surg. 1999;23:998–1002
  12. Fernandez-del Castillo C, Rattner DW, Warshaw AL. Further experience with laparoscopy and peritoneal cytology in the staging of pancreatic cancer. Br J Surg. 1995;82:1127–1129
  13. Borbath I, Van Beers BE, Lonneux M, et al. Preoperative assessment of pancreatic tumors using magnetic resonance imaging, endoscopic ultrasonography, positron emission tomography and laparoscopy. Pancreatology. 2005;5:553–561
  14. Westerdahl J, Andren-Sandberg A, Ihse I. Recurrence of exocrine pancreatic cancer—Local or hepatic?. Hepatogastroenterology. 1993;40:384–387
  15. Griffin JF, Smalley SR, Jewell W, et al. Patterns of failure after curative resection of pancreatic carcinoma. Cancer. 1990;66:56–61
  16. Kalser MH, Ellenberg SS. Pancreatic cancer (Adjuvant combined radiation and chemotherapy following curative resection). Arch Surg. 1985;120:899–903
  17. Gastrointestinal Tumor Study Group. Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Cancer. 1987;59:2006–2010
  18. Foo ML, Gunderson LL, Nagorney DM, et al. Patterns of failure in grossly resected pancreatic ductal adenocarcinoma treated with adjuvant irradiation +/- 5 fluorouracil. Int J Radiat Oncol Biol Phys. 1993;26:483–489
  19. Yeo CJ, Abrams RA, Grochow LB, et al. Pancreaticoduodenectomy for pancreatic adenocarcinoma: Postoperative adjuvant chemoradiation improves survival (A prospective, single-institution experience). Ann Surg. 1997;225:621–633
  20. Demeure MJ, Doffek KM, Komorowski RA, et al. Molecular metastases in stage I pancreatic cancer: Improved survival with adjuvant chemoradiation. Surgery. 1998;124:663–669
  21. Mehta VK, Fisher GA, Ford JM, et al. Adjuvant radiotherapy and concomitant 5-fluorouracil by protracted venous infusion for resected pancreatic cancer. Int J Radiat Oncol Biol Phys. 2000;48:1483–1487
  22. Klinkenbijl JH, Jeekel J, Sahmoud T, et al. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: Phase III trial of the EORTC Gastrointestinal Tract Cancer Cooperative Group. Ann Surg. 1999;230:776–782
  23. Moertel CG, Frytak S, Hahn RG, et al. The Gastrointestinal Tumor Study Group Therapy of locally unresectable pancreatic carcinoma: A randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil. Cancer. 1981;48:1705–1710
  24. Smalley SR, Kimler BF, Evans RG. 5-Fluorouracil modulation of radiosensitivity in cultured human carcinoma cells. Int J Radiat Oncol Biol Phys. 1991;20:207–211
  25. O’Connell MJ, Martenson JA, Wieand HS, et al. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med. 1994;331:502–507
  26. Mehta VK, Poen JC, Ford JM, et al. Protracted venous infusion 5-fluorouracil with concomitant radiotherapy compared with bolus 5-fluorouracil for unresectable pancreatic cancer. Am J Clin Oncol. 2001;24:155–159
  27. Rich TA, Lokich JJ, Chaffey JT. A pilot study of protracted venous infusion of 5-fluorouracil and concomitant radiation therapy. J Clin Oncol. 1985;3:402–406
  28. Poen JC, Collins HL, Niederhuber JE, et al. Chemo-radiotherapy for localized pancreatic cancer: Increased dose intensity and reduced acute toxicity with concomitant radiotherapy and protracted venous infusion 5-fluorouracil. Int J Radiat Oncol Biol Phys. 1998;40:93–99
  29. Shewach DS, Lawrence TS. Radiosensitization of human solid tumor cell lines with gemcitabine. Semin Oncol. 1996;23:65–71
  30. Demols A, Peeters M, Polus M, et al. Adjuvant gemcitabine and concurrent continuous radiation (45 Gy) for resected pancreatic head carcinoma: A multicenter Belgian phase II study. Int J Radiat Oncol Biol Phys. 2005;62:1351–1356
  31. Allen AM, Zalupski MM, Robertson JM, et al. Adjuvant therapy in pancreatic cancer: Phase I trial of radiation dose escalation with concurrent full-dose gemcitabine. Int J Radiat Oncol Biol Phys. 2004;59:1461–1467
  32. Picozzi VJ, Kozarek RA, Traverso LW. Interferon-based adjuvant chemoradiation therapy after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am J Surg. 2003;185:476–480
  33. Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004;350:1200–1210
  34. Choti MA. Adjuvant therapy for pancreatic cancer—The debate continues. N Engl J Med. 2004;350:1249–1251
  35. Crane CH, Ben-Josef E, Small W. Chemotherapy for pancreatic cancer. N Engl J Med. 2004;350:2713–2715
  36. Regine WF, Winter KW, Abrams R, et al. RTOG 9704 a phase III study of adjuvant pre and post chemoradiation (CRT) 5-FU vs. gemcitabine for resected pancreatic adenocarcinoma. J Clin Oncol. 2006;24:1802
  37. Oettle H, Post S, Neuhaus P, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: A randomized controlled trial. JAMA. 2007;297:267–277
  38. Kim HJ, Czischke K, Brennan MF, et al. Does neoadjuvant chemoradiation downstage locally advanced pancreatic cancer?. J Gastrointest Surg. 2002;6:763–769
  39. Hoffman JP, Lipsitz S, Pisansky T, et al. Phase II trial of preoperative radiation therapy and chemotherapy for patients with localized, resectable adenocarcinoma of the pancreas: An Eastern Cooperative Oncology Group study. J Clin Oncol. 1998;16:317–323
  40. Talamonti MS, Small W, Mulcahy MF, et al. A multi-Institutional phase II trial of preoperative full-dose gemcitabine and concurrent radiation for patients with potentially resectable pancreatic carcinoma. Ann Surg Oncol. 2005;12:1–9
  41. Moore MJ, Goldstein D, Hamm J, et al. Erlotinib plus gemcitabine compared to gemcitabine alone in patients with advanced pancreatic cancer (A phase III trial of the National Cancer Institute of Canada Clinical Trials Group [NCIC-CTG]). J Clin Oncol. 2005;23:1;(suppl 16, abstr)
  42. Ramanathan RK, Lee KM, McKolanis J, et al. Phase I study of a MUC1 vaccine composed of different doses of MUC1 peptide with SB-AS2 adjuvant in resected and locally advanced pancreatic cancer. Cancer Immunol Immunother. 2005;54:254–264

 Research funding received from Lilly, Genetech, and Sanofi-Aventis.

PII: S0093-7754(07)00101-7

doi: 10.1053/j.seminoncol.2007.05.006

Seminars in Oncology
Volume 34, Issue 4 , Pages 321-326 , August 2007