Treatment Option Overview
Note: Some citations in the text of this section are followed by a level of
evidence. The PDQ editorial boards use a formal ranking system to help the
reader judge the strength of evidence linked to the reported results of a
therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more
information.)
The survival rate of patients with any stage of pancreatic exocrine cancer is
poor. Clinical trials are appropriate alternatives for treatment of patients
with any stage of disease and should be considered prior to selecting
palliative approaches. To provide optimal palliation, determination of
resectability must be made. Staging studies for resectability include helical
computed tomographic scan, magnetic resonance imaging scan, and endoscopic
ultrasound. The introduction of minimally invasive techniques, such as
laparoscopy and laparoscopic ultrasound, may decrease the use of
laparotomy.[1,2] Surgical resection remains the primary modality when feasible
since, on occasion, resection can lead to long-term survival and provides
effective palliation.[3-5][Level of evidence: 3iA] The role of postoperative therapy (chemotherapy with or without chemoradiation therapy) in the management of this disease remains controversial because much of the randomized clinical trial data available are statistically underpowered and provide conflicting results.[6-10] Frequently, malabsorption
caused by exocrine insufficiency contributes to malnutrition. Attention to
pancreatic enzyme replacement can help alleviate this problem. (Refer to the
PDQ summary on Nutrition in Cancer Care for more information.) Celiac axis (and intrapleural)
nerve blocks can provide highly effective and long-lasting control of pain for
some patients.
Information about ongoing clinical trials is available from the NCI Web site.
References
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John TG, Greig JD, Carter DC, et al.: Carcinoma of the pancreatic head and periampullary region. Tumor staging with laparoscopy and laparoscopic ultrasonography. Ann Surg 221 (2): 156-64, 1995.
[PUBMED Abstract]
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Minnard EA, Conlon KC, Hoos A, et al.: Laparoscopic ultrasound enhances standard laparoscopy in the staging of pancreatic cancer. Ann Surg 228 (2): 182-7, 1998.
[PUBMED Abstract]
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Yeo CJ, Cameron JL, Lillemoe KD, et al.: Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients. Ann Surg 221 (6): 721-31; discussion 731-3, 1995.
[PUBMED Abstract]
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Conlon KC, Klimstra DS, Brennan MF: Long-term survival after curative resection for pancreatic ductal adenocarcinoma. Clinicopathologic analysis of 5-year survivors. Ann Surg 223 (3): 273-9, 1996.
[PUBMED Abstract]
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Yeo CJ, Abrams RA, Grochow LB, et al.: Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg 225 (5): 621-33; discussion 633-6, 1997.
[PUBMED Abstract]
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Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Gastrointestinal Tumor Study Group. Cancer 59 (12): 2006-10, 1987.
[PUBMED Abstract]
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Kalser MH, Ellenberg SS: Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 120 (8): 899-903, 1985.
[PUBMED Abstract]
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Klinkenbijl JH, Jeekel J, Sahmoud T, et al.: Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 230 (6): 776-82; discussion 782-4, 1999.
[PUBMED Abstract]
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Neoptolemos JP, Dunn JA, Stocken DD, et al.: Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet 358 (9293): 1576-85, 2001.
[PUBMED Abstract]
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Neoptolemos JP, Stocken DD, Friess H, et al.: A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 350 (12): 1200-10, 2004.
[PUBMED Abstract]
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