Journal Mobile Options
Table of Contents
Vol. 72, No. 5-6, 2007
Issue release date: February 2008
Oncology 2007;72:314–321

The Role of Adjuvant Chemotherapy for Patients with Resected Pancreatic Cancer: Systematic Review of Randomized Controlled Trials and Meta-Analysis

Boeck S. · Ankerst D.P. · Heinemann V.
aDepartment of Internal Medicine III, Klinikum Grosshadern and bInstitute for Medical Informatics, Biometry and Epidemiology, Ludwig Maximilians University of Munich, Munich, Germany

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


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 / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Ozols RF, Herbst RS, Colson YL, et al: Clinical cancer advances 2006: major research advances in cancer treatment, prevention, and screening – a report from the American Society of Clinical Oncology. J Clin Oncol 2007;25:146–162.
  2. Beger HG, Rau B, Gansauge F, et al: Treatment of pancreatic cancer: challenge of the facts. World J Surg 2003;27:1075–1084.
  3. Cress RD, Yin D, Clarke L, et al:Survival among patients with adenocarcinoma of the pancreas: a population-based study (United States). Cancer Causes Control 2006;17:403–409.
  4. Alexakis N, Halloran C, Raraty M, et al: Current standards of surgery for pancreatic cancer. Br J Surg 2004;91:1410–1427.
  5. Karpoff HM, Klimstra DS, Brennan MF, et al: Results of total pancreatectomy for adenocarcinoma of the pancreas. Arch Surg 2001;136:44–47.
  6. Lüttges J, Vogel I, Menke M, et al: The retroperitoneal resection margin and vessel involvement are important factors determining survival after pancreaticoduodenectomy for ductal adenocarcinoma of the head of the pancreas. Virchow Arch 1998;433:237–242.
  7. Oettle H, Post S, Neuhaus P, et al: Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer. JAMA 2007;297:267–277.
  8. Peto R, Pike MC, Armitage P, et al: Design and analysis of randomized clinical trials requiring prolonged observation of each patient: analysis and examples (II). Br J Cancer 1977;35:1–39.
  9. Cooper H, Hedges LV: The Handbook of Research Synthesis. New York, Russell Sage Foundation, 1994, pp 231–284.
  10. Bakkevold KE, Arnesjø B, Dahl O, et al: Adjuvant combination chemotherapy (AMF) following radical resection of carcinoma of the pancreas and papilla of vater – results of a controlled, prospective, randomised multicentre study. Eur J Cancer 1993;29:698–703.

    External Resources

  11. Kosuge T, Kiuchi T, Mukai K, et al: A multicenter randomized controlled trial to evaluate the effect of adjuvant cisplatin and 5-fluorouracil therapy after curative resection in cases of pancreatic cancer. Jpn J Clin Oncol 2006;36:159–165.
  12. Takada T, Amano H, Yasuda H, et al: Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer 2002;95:1685–1695.
  13. Neoptolemos JP, Dunn JA, Stocken DD, et al: Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomized controlled trial. Lancet 2001;358:1576–1585.
  14. Neoptolemos JP, Stocken DD, Friess H, et al: A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004;350:1200–1210.
  15. Stocken DD, Büchler MW, Dervenis C, et al: Meta-analysis of randomized adjuvant therapy trials for pancreatic cancer. Br J Cancer 2005;92:1372–1381.
  16. Khanna A, Walker GR, Livingstone AS, et al: Is adjuvant 5-FU-based chemoradiotherapy for resectable pancreatic adenocarcinoma beneficial? A meta-analysis of an unanswered question. J Gastrointest Surg 2006;10:689–697.
  17. Hochster HS, Haller DG, De Gramont A, et al: Consensus report of the International Society of Gastrointestinal Oncology on therapeutic progress in advanced pancreatic cancer. Cancer 2006;107:676–685.
  18. Kalser MH, Ellenberg SS: Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 1985;120:899–903.
  19. Gastrointestinal Tumour Study Group: Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Cancer 1987;59:2006–2010.
  20. Klinkenbijl JH, Jeekel J, Sahmoud T, et al: Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 1999;230:776–784.
  21. Regine WF, Winter KW, Abrams R, et al: RTOG 9704 a phase III study of adjuvant pre and post chemoradiation (CRT) 5-FU vs. gemcitabine (G) for resected pancreatic adenocarcinoma (abstract 4007). J Clin Oncol 2006;24:180s.

    External Resources

  22. Blackstock AW, Mornex F, Partensky C, et al: Adjuvant gemcitabine and concurrent radiation for patients with resected pancreatic cancer: a phase II study. Br J Cancer 2006;95:260–265.
  23. Wilkowski R, Thoma M, Duhmke E, et al: Concurrent chemoradiotherapy with gemcitabine and cisplatin after incomplete (R1) resection of locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2004;58:768–772.
  24. Knaebel HP, Märten A, Schmidt J, et al: Phase III trial of postoperative cisplatin, interferon α-2b, and 5-FU combined with external radiation treatment versus 5-FU alone for patients with resected pancreatic adenocarcinoma – CapRI: study protocol. BMC Cancer 2005;5:37–44.
  25. Crane CH, Ellis LM, Abbruzzese JL, et al: Phase I trial evaluating the safety of bevacizumab with concurrent radiotherapy and capecitabine in locally advanced pancreatic cancer. J Clin Oncol 2006;24:1145–1151.
  26. Boeck S, Stieber P, Holdenrieder S, et al: Prognostic and therapeutic significance of carbohydrate antigen 19-9 as tumor marker in patients with pancreatic cancer. Oncology 2006;70:255–264.
  27. Ferrone CR, Finkelstein DM, Thayer SP, et al: Perioperative CA 19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma. J Clin Oncol 2006;24:2897–2902.
  28. Berger AC, Winter K, Hoffmann J, et al: Post-resection CA 19-9 predicts overall survival (OS) in patients treated with adjuvant chemoradiation: A secondary endpoint of RTOG 9704 (abstract 4522). J Clin Oncol 2007;25:203s.

    External Resources

  29. Neoptolemos JP, Stocken DD, Dunn JA, et al: Influence of resection margins on survival for patients with pancreatic cancer treated with adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial. Ann Surg 2001;234:758–768.
  30. Verbeke CS, Leitch D, Menon KV, et al: Redefining the R1 resection in pancreatic cancer. Br J Surg 2006;93:1232–1237.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50