Consideration of Therapeutic Options

Following complete staging, including medical history, physical examination, serum CA 19-9 assessment, CT staging, and tissue diagnosis with EUS-guided FNA, in most patients disease is sufficiently staged to permit discussion of therapeutic options.

Evidence-based interpretation of the literature suggests that the standard of care for patients with localized pancreatic adenocarcinoma remains pancreatectomy alone (Pisters et al, 2003). Unfortunately, the long-term outcome for patients with pancreatic adenocarcinoma treated using surgery alone is poor, with a median survival duration of 11 to 12 months and a 5-year survival rate of approximately 10% (Gastrointestinal

Tumor Study Group, 1987; Bakkevold et al, 1993; Klinkenbijl et al, 1999; Neoptolemos et al, 2001). Consequently, there is still considerable interest in investigational strategies for patients with localized pancreatic adeno-carcinoma. Indeed, we are currently studying 2 separate lines of in-vestigational treatment in these patients: preoperative and postoperative combined-modality therapy.

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