Update in the Management of Locally Advanced Pancreatic Cancer-Focusing on the Strategy of Induction Chemotherapy Followed by Chemoradiotherapy

Abstract

Even though pancreatic cancer accounts for only 2% of all cancer diagnoses in Taiwan, it is one of the ten leading causes of cancer death and the most difficult malignancy to manage. Because of the usually late onset symptoms, hall of the patients presented with metastatic disease. Only 10-15% of patients had resectable disease at initial diagnosis. Around 30% of patients present with locally advanced disease that precludes resection. The use of chemoradiotherapy for locally advanced pancreatic cancer (LAPC) is based on few randomized trials. Recent meta-analysis revealed a survival benefit for chemoradiotherapy over radiotherapy alone; however, chemoradiotherapy did not demonstrate significant survival advantage over chemotherapy alone. Because of similar outcome and lower toxicity, gemcitabine based chemotherapy is considered as a standard of care in many clinical situations. However, there is much controversy about the role of radiotherapy in local disease control. This paper reviews the current management options, controversies, and ongoing and future directions for the treatment of LAPC, focusing on the role of radiotherapy. The rationale and results of our phaseⅡ study on LAPC using induction chemotherapy followed by chemoradiation (TCOG1204) will be presented.