Clinical Study

The Role of Adjuvant Chemotherapy for Patients with Resected Pancreatic Cancer: Systematic Review of Randomized Controlled Trials and Meta-Analysis
Stefan Boeck^a, Donna Pauler Ankerst^b, Volker Heinemann<sup>a

a</sup>Department of Internal Medicine III, Klinikum Grosshadern and
^bInstitute for Medical Informatics, Biometry and Epidemiology, Ludwig Maximilians University of Munich, Munich, Germany

Address of Corresponding Author

Oncology 2007;72:314-321 (DOI: 10.1159/000113054)

  Key Words

• Adjuvant chemotherapy
• Chemoradiation
• Meta-analysis
• Pancreatic cancer

  Abstract

Background: In patients undergoing surgery for resectable pancreatic cancer prognosis still remains poor. The role of adjuvant treatment strategies (including chemotherapy and chemoradiotherapy) following resection of pancreatic cancer remains controversial. Methods: A Medline-based literature search was undertaken to identify randomized controlled trials that evaluated adjuvant chemotherapy after complete macroscopic resection for cancer of the exocrine pancreas. Five trials of adjuvant chemotherapy were eligible and critically reviewed for this article. A meta-analysis (based on published data) was performed with survival (median survival time and 5-year survival rate) being the primary endpoint. Results: For the meta-analysis, 482 patients were allocated to the chemotherapy group and 469 patients to the control group. The meta-analysis estimate for prolongation of median survival time for patients in the chemotherapy group was 3 months (95% CI 0.3-5.7 months, p = 0.03). The difference in 5-year survival rate was estimated with 3.1% between the chemotherapy and the control group (95% CI -4.6 to 10.8%, p > 0.05). Conclusion: Currently available data from randomized trials indicate that adjuvant chemotherapy after resection of pancreatic cancer may substantially prolong disease-free survival and cause a moderate increase in overall survival. In the current meta-analysis, a significant survival benefit was only seen with regard to median survival, but not for the 5-year survival rate. The optimal chemotherapy regimen in the adjuvant setting as well as individualized treatment strategies (also including modern chemoradiotherapy regimens) still remain to be defined.

Copyright © 2008 S. Karger AG, Basel

  Author Contacts

Prof. Dr. Volker Heinemann
Department of Internal Medicine III, Klinikum Grosshadern
Ludwig Maximilians University of Munich, Marchioninistr. 15
DE-81377 Munich (Germany), Tel. +49 89 7095 2208, Fax +49 89 7095 5256
E-Mail volker.heinemann@med.uni-muenchen.de

  Article Information

Received: August 13, 2007
Accepted: August 13, 2007
Published online: January 14, 2008
Number of Print Pages : 8
Number of Figures : 3, Number of Tables : 3, Number of References : 30