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Adjuvant radiotherapy for resected pancreatic cancer: a lack of benefit or a lack of adequate trials?

Nature Clinical Practice Gastroenterology & Hepatology volume 6, pages 38–46 (2009)Cite this article

Abstract

Surgical resection is the most effective means of controlling nonmetastatic pancreatic cancer, but recurrence rates are high even after complete resection. For several types of tumor of the gastrointestinal tract, combined modality therapy that includes radiation therapy has been shown to reduce the recurrence rate and improve disease-free survival. The use of adjuvant radiotherapy for pancreatic cancer, however, is controversial. Results of the few randomized trials of adjuvant radiotherapy for pancreatic cancer are conflicting. In addition, as pancreatic cancer is associated with high rates of distant recurrence, the additional benefit provided by local therapy has been perceived as questionable. This article reviews the studies—prospective and retrospective—of adjuvant radiotherapy for pancreatic cancer and the issues surrounding the use of this strategy.

Key Points

  • The use of adjuvant radiotherapy for resected pancreatic cancer is controversial, and results of randomized controlled trials are conflicting

  • In the absence of adjuvant therapy, local failure rates could exceed 50% after resection of pancreatic adenocarcinoma

  • The rationale for adjuvant radiotherapy for pancreatic adenocarcinoma is to improve locoregional control

  • Modern radiation delivery techniques permit dose escalation in order to reduce normal tissue toxic effects and simultaneously deliver increased doses of radiation to affected areas

  • Future randomized controlled trials for resected pancreatic cancer should strive to identify subgroups of patients most likely to benefit from adjuvant radiotherapy

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Authors and Affiliations

  1. SL Liauw is an Assistant Professor in the Department of Radiation and Cellular Oncology, and RR Weichselbaum is the Daniel K Ludwig Professor and Chairman of the Department of Radiation and Cellular Oncology and Head of the Ludwig Cancer for Metastasis at the University of Chicago, R Gutt is a Resident in Radiation Oncology, IL, USA.,

    Ruchika Gutt, Stanley L Liauw & Ralph R Weichselbaum

Authors
  1. Ruchika Gutt
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  2. Stanley L Liauw
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  3. Ralph R Weichselbaum
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Corresponding author

Correspondence to Stanley L Liauw.

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Competing interests

Ralph R Weichselbaum is a consultant and stockholder for GenVec Inc. The other authors declared no competing interests.

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Gutt, R., Liauw, S. & Weichselbaum, R. Adjuvant radiotherapy for resected pancreatic cancer: a lack of benefit or a lack of adequate trials?. Nat Rev Gastroenterol Hepatol 6, 38–46 (2009). https://doi.org/10.1038/ncpgasthep1301

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