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Clinical and Translational Oncology

, Volume 19, Issue 10, pp 1199–1204 | Cite as

Adjuvant treatment for pancreatic ductal carcinoma

  • T. MacarullaEmail author
  • T. Fernández
  • M. E. Gallardo
  • O. Hernando
  • A. M. López
  • M. Hidalgo
Review article

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a tumor with a very poor prognosis. Most of the patients are diagnosed in advanced stages of the disease, and 5-year survival rates in these patients remains <10%. Surgery still remains the only radical treatment option, although only 15–20% of patients are candidates for surgical resection at the time of the diagnosis. Patients who undergo radical surgery still have a limited survival rate, being the average of 23 months. Three clinical trials have shown that adjuvant chemotherapy therapy after surgery may improve survival: CONKO-1, ESPAC-3, and ESPAC-4. Adjuvant therapy is recommended in patients with R0/R1, T1-4/N1-0 tumors and with ECOG 0-1. In patients with ECOG-2, the decision needs to be individualized. Treatment schemes that have demonstrated efficacy include gemcitabine alone, 5-fluorouracil, or the combination of gemcitabine and capecitabine for six months. Prior to adjuvant treatment, the following test are recommended: Complete blood tests, including CA19.9 biomarker; imaging studies to rule out early disease relapse (preferable thorax-abdomen-pelvic CT). Studies that have evaluated the efficacy of radiation therapy in the adjuvant setting have presented conflicting results. Its use should be considered in patients with R1 or R2 tumors or in those with lymph nodes involved.

Keywords

Adjuvant Pancreatic ductal adenocarcinoma Neoadjuvant Surgery Chemotherapy Radiotherapy 

Notes

Acknowledgements

The authors thank Sofía Perea, Pharm D, PhD, for her support in writing the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare to have no conflict of interest.

Funding

The support for medical writing was supported by Fundación ECO.

Informed consent

NA.

Research involving human participants and/or animals

NA.

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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2017

Authors and Affiliations

  1. 1.Department Medical OncologyHospital Vall d’HebrónBarcelonaSpain
  2. 2.Department Medical OncologyHospital Son LlàtzerPalma De MallorcaSpain
  3. 3.Department Medical OncologyComplejo Hospitalario Universitario de PontevedraPontevedraSpain
  4. 4.Department Radiation OncologyHospital Universitario HM SanchinarroMadridSpain
  5. 5.Department Radiation OncologyHospital Universitario HM Puerta del SurMadridSpain
  6. 6.Department Medical OncologyHospital Universitario de BurgosBurgosSpain
  7. 7.Beth Israel Deaconness Medical CenterHarvard Medical SchoolBostonUSA

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