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Canadian Journal of Gastroenterology
Volume 17, Issue 3, Pages 161-167
Original Article

The Treatment of Locally Advanced Pancreatic Cancer: A Practice Guideline

Craig C Earle,1 Olusegun Agboola,2 Jean Maroun,2 Lisa Zuraw,3 and Cancer Care Ontario Practice Guidelines Initiative’s Gastrointestinal Cancer Disease Site Group

1Dana-Farber Cancer Institute, Boston, Massachussetts, USA
2Ottawa Regional Cancer Centre, Ottawa, Ontario, Canada
3Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

Received 26 July 2002; Revised 10 December 2002

Copyright © 2003 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Pancreatic adenocarcinoma is the fourth most common cause of adult cancer death. About 50% of patients present with metastatic disease, 20% with resectable disease and the remaining 30% of patients are diagnosed with incurable, locally advanced unresectable but nonmetastatic pancreatic cancer.

OBJECTIVES: To evaluate the current evidence regarding treatment of incurable, locally advanced, unresectable but nonmetastatic pancreatic cancer and produce an evidence-based practice guideline.

METHODS: A systematic review of the literature was performed. The MEDLINE, CANCERLIT, and Cochrane Library databases were searched using the following medical subject heading search terms: ‘pancreatic neoplasms’, ‘chemotherapy, adjuvant’, ‘radiotherapy’, ‘immunotherapy’, combined with the text words: ‘chemotherapy’, ‘radiotherapy’, ‘radiation’, ‘immunotherapy’, combined with terms for the following study designs or publication types: practice guidelines, meta-analyses and randomized controlled trials. The Physician Data Query clinical trials database and the proceedings of the annual meetings of the American Society of Clinical Oncology (1996 to 2001) and the American Society for Therapeutic Radiology and Oncology (1999 to 2001) were searched for reports of new or ongoing trials. Relevant literature was selected and reviewed independently, and the reference lists from these sources were searched for additional trials. Interpretation of evidence was resolved by consensus.

RESULTS: Eight randomized trials were obtained that met the inclusion criteria.

CONCLUSIONS: Recommendations are to offer combined chemotherapy and radiotherapy to suitable patients. The preferred chemotherapeutic agent to combine with radiotherapy is bolus or infusional 5-fluorouracil, but the optimal mode and duration of 5-fluorouracil delivery is unclear. Chemotherapy alone with gem-citabine is an acceptable alternative.