Chemotherapy for Pancreatic Cancer

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Abstract
Neoptolemos et al. (March 18 issue)1 report the results of a trial conducted by the European Study Group for Pancreatic Cancer (ESPAC-1), which showed a survival advantage for adjuvant chemotherapy, but a deleterious effect of chemoradiotherapy. We would like to emphasize the suboptimal nature of the radiotherapy delivered in this trial. The regimen of chemoradiotherapy used was taken from the Gastrointestinal Tumor Study Group (GITSG) trial,2 which was reported in 1985 but conceived in the early 1970s. The use of a split-course technique prolongs the overall treatment time and is known to reduce the rate of local control.3 It is now well established that fluorouracil can be safely delivered with radiotherapy in doses of 45 to 54 Gy, given in fractions of 1.8 Gy daily.4 The routine availability of computed tomography for planning and delivery of conformal treatment permits precise targeting and minimizes the risk to normal organs. Improvements in quality assurance and technique have established the benefit of chemoradiotherapy after surgery for stomach cancer, whereas previously it was thought that there was none.5,6 We believe that the role of optimal chemoradiotherapy after resection of pancreatic cancer remains unclear and that it is worthy of consideration in future trials.