Postoperative Adjuvant Therapy in Pancreatic and Biliary Tract Carcinoma

Tadahiro Takada

The First Department of Surgery, Teikyo University School of Medicine

Chemo-radiotherapy has been a common modality of postoperative adjuvant therapy in pancreatic carcinoma in Europe and the United States. In many opinions, chemo-radiotherapy seems to be effective in controlling the local recurrence, but a remarkable improvement of survival has not been proven. Loco-regional chemotherapy to prevent hepatic metastasis after surgical resection is recognized as one of the promising postoperative adjuvant therapies. Recently several clinical trials to evaluate pre- and intraoperative adjuvant therapy are ongoing in Europe and the United States, while there are only a few reports showing effectiveness of postoperative radiotherapy in biliary tract carcinoma. In the results of our randomized controlled trial (Japanese Study Group of Surgical Adjuvant Therapy for Carcinoma of the Pancreas and Biliary Tract) in resected patients, a significant improvement of survival by postoperative systemic chemotherapy was observed in non-curatively resected gallbladder carcinoma, but not in pancreatic and bile duct carcinoma. We think that this result consists with our previous 2 trials in nonresected patients showing that FAM combination chemotherapy suppressed disease progression in only gallbladder carcinoma. In the CD-DST, primary culture was successful in all 16 patients with pancreatic and biliary tract carcinoma. They were most sensitive to 5-FU, MMC and ADR among the 6 tested drugs, and positive rate in these drugs tended to be higher in biliary tract carcinoma than in pancreatic carcinoma. At present we are evaluating the correlation between clinical outcome and sensitivity in CD-DST in additional patients.

Key words
postoperative adjuvant therapy, pancreatic and biliary tract carcinoma, collagen gel droplet embedded culture drug sensitivity test

Reprint requests
Tadahiro Takada The Frist Department of Surgery, Teikyo University School of Medicine
2-11-1 Kaga, Itabashi, Tokyo, 173-8605 JAPAN

Accepted
May 19, 1998

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