The treatment of locally advanced pancreatic cancer

In: Pancreatic cancer

13 Jul 2012

Adenocarcinoma of the exocrine pancreas

Adenocarcinoma of the exocrine pancreas is the fourth most common cause of cancer death in adults. Smoking and a history of chronic pancreatitis are established risk factors, and data are emerging to support occasional inherited susceptibilities, as well as increased risk from a high-fat diet. It is highly lethal, with only 5% of patients alive at five years.

About 50% of patients present with metastatic disease and have a median survival time of less than six months, with a one-year survival rate of less than 20%. Twenty percent present with localized resectable disease, and up to one-quarter of these patients can be cured with surgery, with adjuvant chemoradiotherapy possibly increasing the cure rate. The remaining 30% of patients are diagnosed with incurable, locally advanced, unresectable but nonmetastatic pancreatic cancer.

Resection of locally advanced pancreatic cancer is usually not possible because of invasion of the portal or superior mesenteric vessels, splenic vein thrombosis or metastases to second level lymph nodes. Patients have a median survival time of six to 10 months and a one-year survival rate of 20% to 40%. Several clinical trials have explored the value of chemotherapy and/or radiotherapy in this group of patients. A systematic review of this literature and a practice guideline on the topic are therefore warranted. The practice guideline was intended to make recommendations regarding the optimal treatment for patients with locally advanced (unresectable but nonmetastatic) pancreatic cancer. Outcomes of interest were overall survival, disease-free survival, local control, adverse effects and quality of life.


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