Fluorouracil vs Gemcitabine Chemotherapy Before and After Fluorouracil-Based Chemoradiation Following Resection of Pancreatic Adenocarcinoma

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Abstract
Despite potentially curative resection for pancreatic adenocarcinoma, patterns of failure analyses demonstrate a 50% to 85% component of local relapse associated with liver and intra-abdominal failure and a 5-year survival of less than 20%.1-5 The frequency and pattern of failure make the combination of adjuvant postoperative chemotherapy and radiation an important consideration. Phase 3 trials have demonstrated long-term survival of up to 20% of patients with resected adenocarcinoma of the pancreas treated with adjuvant fluorouracil-based chemoradiation (chemotherapy plus radiation).6-8 Although these trials have been small, their findings, combined with large institutional results,9,10 have supported the use of postoperative adjuvant chemoradiation with fluorouracil as a standard of care in the United States for more than 20 years.