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Adjuvant treatment for pancreatic ductal carcinoma

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Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a tumor with a very poor prognosis. Most of the patients are diagnosed in advanced stages of the disease, and 5-year survival rates in these patients remains <10%. Surgery still remains the only radical treatment option, although only 15–20% of patients are candidates for surgical resection at the time of the diagnosis. Patients who undergo radical surgery still have a limited survival rate, being the average of 23 months. Three clinical trials have shown that adjuvant chemotherapy therapy after surgery may improve survival: CONKO-1, ESPAC-3, and ESPAC-4. Adjuvant therapy is recommended in patients with R0/R1, T1-4/N1-0 tumors and with ECOG 0-1. In patients with ECOG-2, the decision needs to be individualized. Treatment schemes that have demonstrated efficacy include gemcitabine alone, 5-fluorouracil, or the combination of gemcitabine and capecitabine for six months. Prior to adjuvant treatment, the following test are recommended: Complete blood tests, including CA19.9 biomarker; imaging studies to rule out early disease relapse (preferable thorax-abdomen-pelvic CT). Studies that have evaluated the efficacy of radiation therapy in the adjuvant setting have presented conflicting results. Its use should be considered in patients with R1 or R2 tumors or in those with lymph nodes involved.

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Acknowledgements

The authors thank Sofía Perea, Pharm D, PhD, for her support in writing the manuscript.

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Authors and Affiliations

  1. Department Medical Oncology, Hospital Vall d’Hebrón, Pg Vall d’Hebrón 119, Barcelona, Spain

    T. Macarulla

  2. Department Medical Oncology, Hospital Son Llàtzer, Palma De Mallorca, Spain

    T. Fernández

  3. Department Medical Oncology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain

    M. E. Gallardo

  4. Department Radiation Oncology, Hospital Universitario HM Sanchinarro, Madrid, Spain

    O. Hernando

  5. Department Radiation Oncology, Hospital Universitario HM Puerta del Sur, Madrid, Spain

    O. Hernando

  6. Department Medical Oncology, Hospital Universitario de Burgos, Burgos, Spain

    A. M. López

  7. Beth Israel Deaconness Medical Center, Harvard Medical School, Boston, USA

    M. Hidalgo

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  1. T. Macarulla
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  6. M. Hidalgo
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Correspondence to T. Macarulla.

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The authors declare to have no conflict of interest.

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The support for medical writing was supported by Fundación ECO.

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Macarulla, T., Fernández, T., Gallardo, M.E. et al. Adjuvant treatment for pancreatic ductal carcinoma. Clin Transl Oncol 19, 1199–1204 (2017). https://doi.org/10.1007/s12094-017-1683-5

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  • DOI: https://doi.org/10.1007/s12094-017-1683-5

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