Possibilities and limits of cytostatic chemotherapy in pancreatic carcinoma

: The investigation of chemotherapy for pancreatic cancer has been hampered by the fact that most patients present with severe general illness and thus tolerate this form of treatment poorly. Furthermore, because of the relative inaccessibility of the pancreas it has been difficult to monitor objective response rates. In patients with disseminated disease only few drugs have shown antitumour activity and the response rates generally do not exceed 20%. Several combination regimens have been tested. Of those assessed in randomized trials, the median survival has ranged from 2 to 6.5 months, which is not significantly better than with supportive therapy alone. Endocrine treatment measures and certain experimental treatment approaches such as reversal of multidrug resistance, photodynamic therapy and radioimmunotherapy may represent promising fields for future research. Encouraging preliminary results, however, warrant confirmation in controlled clinical trials. In patients with unresectable though localized pancreatic tumours the use of conventional external-beam radiation therapy plus 5-fluorouracil can significantly increase survival. Combined radiochemotherapy also seems to play an important role in the postoperative adjuvant treatment of potentially curative tumours, increasing the long-term results of surgical management.