Adjuvant Chemotherapy and Radiotherapy in Resected Pancreatic Ductal Adenocarcinoma: A Systematic Review and Clinical Practice Guideline

Adjuvant Chemotherapy and Radiotherapy in Resected Pancreatic Ductal Adenocarcinoma: A Systematic Review and Clinical Practice Guideline

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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 Food Service:Commercial Kitchen Equipment:Food Preparation Equipment:Prep Tables:Work Tables 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 Terminal Blocks:Wire 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.