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Treatment of advanced pancreatic cancer.

Metastatic pancreatic cancer afflicts the vast majority of patients diagnosed with this disease: it is calculated that, overall, pancreatic cancer is the fourth most common cause of cancer death, that the overall survival at 5 years is <5% and that at diagnosis more than half of the patients have advanced disease with distant metastases. In the case of locally advanced disease without distant metastases, there is a possible role for chemoradiation. A systematic review [1] clearly indicated that the combination of chemotherapy and radiotherapy is more effective than best supportive care and than radiotherapy alone, but not better (and more toxic) than chemotherapy alone. Also considering the limits of the studies performed so far, a possible strategy for clinical practice could be the consolidation with radiochemotherapy (or even radiotherapy alone) in patients with a disease well controlled (tumour shrinkage or stabilization) with chemotherapy [2]. This approach is now under evaluation in a prospective phase III trial. In metastatic disease the life expectancy is limited to a few months and the role of medical treatment is essentially palliative.