Pancreatic cancer — the role of systemic and combined modality treatment

Abstract

Pancreatic cancer (PC) prognosis is extremely poor. Mortality and incidence rates for this malignant neoplasm reach almost equal values and a 5-year survival rate does not exceed 5%. This is mainly due to the fact that more than 50% of patients present distant metastases at diagnosis and up to 80% of patients after radical surgery, which is the only potentially curative method, experience recurrence within 2 years. Gemcitabine or fluorouracil are now considered the standard of care in the adjuvant setting as such treatment prolongs survival, whereas in palliative therapy gemcitabine or in selected patients FOLFIRINOX are recommended. Optimal management of locally advanced PC remains controversial. In order to improve percentage of radical resections attempts are made to apply neoadjuvant treatment by using chemo- or chemoradiotherapy. However, there are no evidence that such a strategy is associated with improvement in overall survival.

Despite constant searching for new, more effective therapies of PC, results of treatment remain unsatisfactory. For majority of patients, due to advanced disease at diagnosis, palliative chemotherapy remains the only treatment option.