| Autor: |
Biagi JJ; Cancer Centre of Southeastern Ontario, 25 King Street West, Kingston, ON K7L 5P9, Canada., Cosby R; Program in Evidence-Based Care, Department of Oncology, Juravinski Campus, McMaster University, 711 Concession Street, Hamilton, ON L8V 1C3, Canada., Bahl M; Trillium Health Partners, 2200 Ellington Avenue West, Mississauga, ON L5M 2N1, Canada., Elfiki T; Windsor Regional Cancer Centre, 2220 Kildare Road, Windsor, ON N8W 2X3, Canada., Goodwin R; The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada., Hallet J; Odette Cancer Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M4, Canada., Hirmiz K; Windsor Regional Cancer Centre, 2220 Kildare Road, Windsor, ON N8W 2X3, Canada., Mahmud A; Cancer Centre of Southeastern Ontario, 25 King Street West, Kingston, ON K7L 5P9, Canada. |
| Abstrakt: |
Pancreatic cancer is the seventh leading cause of cancer deaths worldwide, accounting for 4.7% of all cancer deaths, and is expected to climb significantly over the next decade. The purpose of this systematic review and guidance document was to synthesize the evidence surrounding the role of adjuvant treatment (chemotherapy and chemoradiation therapy [CRT], and stereotactic body radiation therapy [SBRT]) in resected pancreatic ductal adenocarcinoma (PDAC). Systematic literature searches of MEDLINE, EMBASE, and 11 guideline databases were conducted. Both direct and indirect comparisons indicate adjuvant chemotherapy offers a survival advantage over surgery alone. The optimal regimens recommended are mFOLFIRINOX with alternative options of gemcitabine plus capecitabine, gemcitabine alone, or S-1 (which is not available in North America). Trials comparing a CRT strategy to modern chemotherapy regimens are lacking. However, current evidence demonstrates that the addition of CRT to chemotherapy does not result in a survival advantage over chemotherapy alone and is therefore not recommended. Trials evaluating SBRT in PDAC are also lacking. SBRT should only be used within a clinical trial or multi-institutional registry. |
