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World J Gastroenterol. Apr 14, 2012; 18(14): 1565-1572
Published online Apr 14, 2012. doi: 10.3748/wjg.v18.i14.1565
Adjuvant and neoadjuvant treatment in pancreatic cancer
Marta Herreros-Villanueva, Elizabeth Hijona, Angel Cosme, Luis Bujanda
Marta Herreros-Villanueva, Schulze Center for Novel Therapeutics, Division of Oncology Research, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
Elizabeth Hijona, Angel Cosme, Luis Bujanda, Department of Gastroenterology, Centro de Investigacion Biomédica en Red en Enfermedades Hepáticas y Digestivas, University of the Basque Country, Donostia Hospital, 20014 San Sebastian, Spain
Author contributions: All the authors contributed equally to this work.
Supported by Instituto Salud Carlos III
Correspondence to: Luis Bujanda, MD, PhD, Professor, Department of Gastroenterology, Centro de Investigacion Biomédica en Red en Enfermedades Hepáticas y Digestivas, University of the Basque Country, Donostia Hospital, Paseo Dr. Beguiristain S/N, 20014 San Sebastian, Spain. luis.bujanda@osakidetza.net
Telephone: +34-94-3007173 Fax: +34-94-300706
Received: August 28, 2011
Revised: October 23, 2011
Accepted: January 22, 2012
Published online: April 14, 2012
Abstract

Pancreatic adenocarcinoma is one of the most aggressive human malignancies, ranking 4th among causes for cancer-related death in the Western world including the United States. Surgical resection offers the only chance of cure, but only 15 to 20 percent of cases are potentially resectable at presentation. Different studies demonstrate and confirm that advanced pancreatic cancer is among the most complex cancers to treat and that these tumors are relatively resistant to chemotherapy and radiotherapy. Currently there is no consensus around the world on what constitutes “standard” adjuvant therapy for pancreatic cancer. This controversy derives from several studies, each fraught with its own limitations. Standards of care also vary somewhat with regard to geography and economy, for instance chemo-radiotherapy followed by chemotherapy or vice versa is considered the optimal therapy in North America while chemotherapy alone is the current standard in Europe. Regardless of the efforts in adjuvant and neoadjuvant improved therapy, the major goal to combat pancreatic cancer is to find diagnostic markers, identifying the disease in a pre-metastatic stage and making a curative treatment accessible to more patients. In this review, authors examined the different therapy options for advanced pancreatic patients in recent years and the future directions in adjuvant and neoadjuvant treatments for these patients.

Keywords: Pancreatic ductal adenocarcinoma; Adjuvant; Neoadjuvant; Fluorouracil; Gemcitabine