Pancreatic Cancer: Adjuvant Chemotherapy, but Not Radiation

　　In the treatment of resectable pancreatic cancer, adjuvant chemotherapy (ACT) is a standard of care, whereas the use of adjuvant radiochemotherapy (ARCT) has been controversial.

　　A large, multicenter, retrospective analysis published online February 13 in the Journal of the American College of Surgeons now indicates that the addition of ACT, but not radiation, reduces the risk for distant recurrences and increases overall survival. These data were first presented in December 2015 at the Southern Surgical Association's 127th Annual Meeting, held at Hot Springs, Virginia.安徽省立医院肿瘤科何义富

　　This is the first large, multi-institutional study that demonstrates differences in recurrence patterns in patients with pancreatic cancer on the basis of type of adjuvant therapy. It shows that ACT increases both local recurrence-free survival and distant recurrence-free survival, with a corresponding benefit in overall survival. By contrast, adjuvant chemoradiation therapy (ACRT) provides a benefit in local recurrence-free survival but not in distant recurrence-free survival or overall survival.

　　Does this study settle the debate on the use of ACRT in the clinical management of resectable pancreatic cancer?

　　"The study confirms that adjuvant chemotherapy should be the standard of care following surgery for resectable pancreatic cancer, as has been shown in randomized clinical trials," corresponding author Alexander A. Parikh, MD, MPH, associate professor of surgery and director of the Vanderbilt Pancreas Center at Vanderbilt University Medical Center, Nashville, Tennessee, told Medscape Medical News.

　　"The use of adjuvant chemoradiation, however, only provided a benefit in local recurrence but not distant recurrence or survival. Its benefit, therefore, remains unclear," he added.

　　Medscape Medical News contacted medical oncologists not associated with the study for their perspectives on the study.

　　"This is a thought-provoking study that undertook a thorough analysis to evaluate the role of adjuvant systemic chemotherapy and chemoradiation therapy in local and distant recurrences in patients with pancreatic cancer following surgery," Eileen M. O'Reilly, MD, associate director of the David M. Rubinstein Center for Pancreatic Cancer at the Memorial Sloan Kettering Cancer Center, in New York City, told Medscape Medical News.

　　"While it endorses the use of adjuvant systemic chemotherapy, it leaves the major question of the use of chemoradiation therapy in this setting not definitively answered," she added.

　　"This work addresses an important issue regarding the patterns of recurrence and survival following resection and adjuvant treatment for patients with pancreatic cancer," Ryan D. Nipp, MD, of the Massachusetts General Hospital Cancer Center and the Dana-Farber Harvard Cancer Center, Boston, told Medscape Medical News.