The role of adjuvant chemotherapy for patients with resected pancreatic cancer: Systematic review of randomized controlled trials and meta-analysis

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 > 10.05). 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
(C) 2008 S. Karger AG, Basel.