Current state of adjuvant therapy in resected pancreatic adenocarcinoma

Figures & data

Table I.  Adjuvant chemoradiation and adjuvant chemotherapy.

			Surgical radicality (%)			Actuarial survival (%)
Study	Treatment	No. of patients	RO	NO	Median survival (months)	2-y.	3-y.	5-y.	Comments
Kalser (22)	observation	22	100§	–	10.9	18	–	–	RCT
	Rx + F	21			21.0	43		–
GITSG (23)	Rx + F	30	100	–	18	46			supportive study
Whittington (25)	observation	33	72§	75–78§	15	35	8	–
	Rx + F	19			15	30	5	–
	Rx + F M	20			16	43	34	–
Foo (26)	control	101	–	–	16.5	–	9	4
	control	89			12	25	11	7
	Rx + F	29			22.8	48	24	12
Bakkevold (32)	observation	31	45–70§	–	11	32	30	8	RCT, incl. ampullary neoplasms
	F + A+M	30			23	43	27	4
Yeo (2)	control	53	79	23	13.5	30	–	–
	Rx + F (st.)	99	65	27	21.0	44	–	–
	Rx + F+L (int.)	21	81	24	17.5	22	–	–
Abrams (27)	Rx + F	23	–	–	15.9	30	20	–
Paulino (28)	Rx + F	38	74	53	21	–	16	–	Different protocols used.
Klinkenbijl (30)	observation	104	76§	61§	19.0	41	–	22	RCT, incl. ampullary neoplasms
	Rx + F	103			24.5	51	–	28
Sohn (4)	observation	132	70§	73§	11	30	–	9
	Rx + F (±M±D)	366			19	39	–	20
Mehta (29)	Rx + F	52	65	41	32	62	39	–
ESPAC-1 (36)	observation	69	81–84§	50–58§	16.9	–	–	11	RCT
	Rx + FL	73			14.2	–	–	13
	Rx	73			13.9	–	–	7
	FL	75			21.6	–	–	29

Treatment: Rx: radiotherapy; A: adriamycin; C: cisplatinum; D: dipyridamol; F: 5-flurouracil; IFN: interferon-alpha; L: leukovorin; M: mitomycin C; Mo: mitoxantrone; S: streptozotocin; st.: standard protocol; int.: intensive protocol.

Surgical radicality: Reported proportion of study patients with negative resection margins (RO) and negative lymph nodes (NO). §: refers to all subgroups together.

RCT: randomized controlled study.

Table II.  Regional chemotherapy.

			Surgical radicality (%)			Actuarial survival (%)			Comments
Study	Treatment	No. of patients	RO	NO	Median survival (months)	2-y.	3-y.	5-y.
Ishikawa (41)	control/F	67	81	25	24	–	39	27
	(reg)F	27	81	19	42	–	54	39
Beger (43)	control	25	100§	–	10.5	–	12	–
	C + F+L + Mo	26			23	–	48	–
Ozaki (44)	M + IORT	27	81§	–	30	–	46	31	IORT (20-)30 Gy

Treatment: (reg): regional chemotherapy; IORT: intraoperative radiotherapy; A: adriamycin; C: cisplatinum; D: dipyridamol; F:5-flurouracil; IFN: interferon-alpha; L: leukovorin; M: mitomycin C; Mo: mitoxantrone; S: streptozotocin.

Surgical radicality: Reported proportion of study patients with negative resection margins (RO) and negative lymph nodes (NO).

§ refers to all subgroups together.

Table III.  Neoadjuvant therapy.

			Surgical radicality (%)			Actuarial survival (%)
Study	Treatment	No. of patients	RO	NO	Median survival (months)	2-y.	3-y.	5-y.	Comments
Staley (16)	(Pre)Rx + F	39	82	62	19	33	25	19	IORT 10 Gy
Spitz (50)	(Pre)Rx + F	41	88	54	19.2	39	35	28	IORT 10–15 Gy
	(Post)Rx + F	19	74	37	22.0	52	40	40
Pendurthi (51)	(Pre)Rx + FM	25	72	72	20	40	20	–
	(Post)Rx	18	44	6	25	40	20	–
Hoffman (52)	(Pre)Rx + FM	24	71	81	15.7	27	–	–
Pisters (53)	(Pre)Rx + F	35	90	35	25	60	23	–	IORT 10–15 Gy
Snady (54)	controls	28	–	–	10.5	17	11	–	Different protocols used.
	(Pre)Rx + FSC	20	–	–	32.3	61	32	–
	(Post)Rx + F	63	–	–	16.2	34	13	–
Breslin (55)	(Pre) Rx + F/P/G	132	88	52	21	–	–	23	IORT 10–15 Gy
White (59)	(Pre)Rx + F/M/C	39	72	70	>16	32	–	28	Different protocols used.
Pisters (56)	(Pre)Rx + P	20	68	47	19	–	28	–	IORT 10–15 Gy

Treatment: Rx: radiotherapy; A: adriamycin; cisplatinum; D: dipyridamol; F: 5-flurouracil; IFN:interferon-alpha; L: leukovorin; M: mitomycin C; Mo: mitoxantrone; S: streptozotocin; (Pre): preoperative treatment; (Post): postoperative treatment; IORT: intraoperative radiotherapy.

Surgical radicality: Reported proportion of study patients with negative resection margins (RO) and negative lymph nodes (NO).

Table IV.  Intraoperative radiotherapy.

			Surgical radicality (%)			Actuarial survival (%)
Study	Treatment	No. of patients	RO	NO	Median survival (months)	2-y.	3-y.	5-y.	Comments
Zerbi (61)	control	47	66	–	12	24	7	–
	IORT	43	60.5	–	19	16	10	–
Fossati (62)	Control	44	66	–	12.5	16	10	–
	IORT	32	69	40	19	26	9.9	–
Di Carlo (63)	control	47	–	–	14				Chemotherapy also given
	Adj.+IORT	54	–	–	17
Hosotani (64)	control	64	58	31	7.9	8	8	4
	(Post)Rx/IORT	86	67	46	12.8	14	8	8
Sunamura (65)	control	24	–	–	16.7	–	21	–
	IORT	20	–	–	15	–	18	–
Kokubo (66)	control	39	71	41	11	–	16	–	Chemotherapy also given
	IORT	34	95	–	15	–	25	–
	IORT + Rx	18	–	–	17	–	24	–
Alfieri (67)	control	20	90	55	10.8	–	–	6
	IORT	26	90	50	14.3	–	–	16
Reni (68)	control	19	80§	–	13	28	6	6	Stage I–II subgroup
	IORT	30			18.5	50	28	22

Treatment: Rx: radiotherapy; A: adriamycin; cisplatinum; D: dipyridamol; F: 5-flurouracil; IFN: interferon-alpha; L: leukovorin; M: mitomycin C; Mo: mitoxantrone; S: streptozotocin; (Pre): preoperative treatment; (Post): postoperative treatment; IORT: intraoperative radiotherapy.

Surgical radicality: Reported proportion of study patients with negative resection margins (RO) and negative lymph nodes (NO).

§ refers to all subgroups together.