[Fight against cancer of the exocrine pancreas: stagnation or progress? The point of view of the Fondation française de cancérologie digestive (FFCD)]

[Chemoradiation in pancreatic carcinoma]

Prognosis of pancreatic carcinoma remains poor, with one-year and five-year overall survival rates of 20 and 5% respectively. Only 5 to 15% of patients present with tumors amenable to resection. Long-term (5 years) survival after curative resection is less than 20%, and the median survival is about 12 months. This paper updates recent trends about concomitant chemoradiation. At first, a review of the studies on adjuvant chemoradiation after surgery is proposed. Then, indications of preoperative chemoradiation for patients with localized resectable adenocarcinoma are discussed. The last part concerns the most important and recent studies about chemoradiation in locally advanced pancreatic cancer, either with 5-fluoro-uracile or based on new drugs like gemcitabine.

[Management of pain in pancreatic cancer]

Pain remains an indicator of progression of cancer of the pancreas. Regular pain evaluation combined with early analgesic treatment improves the duration and quality of life. New modes of morphine administration and specific chemotherapy can improve this management. Neurolysis is more effective in the case of recent pain, previously controlled by anti-inflammatory drugs. The endoscopic ultrasound (EUS)-guided technique allows celiac block during EUS examination for local staging. Early introduction of palliative surgery and analgesic procedures can reduce the morbidity and mortality of these procedures. A graduated multidisciplinary pain management program allows optimal pain control.

[Adenocarcinoma of the exocrine pancreas: management and therapeutic hopes]

INTRODUCTION

Pancreatic carcinoma is a major public health concern, as it kills more than 6,000 people each year in France.

CURRENT KNOWLEDGE AND KEY POINTS

The main risk factor demonstrated by concordant case-control studies is cigarette smoking. Pancreatic carcinoma is generally diagnosed at an advanced stage. Results of radical surgery are still poor. In most of the reported series, less than 25% of the patients survive at five years.

FUTURE PROSPECTS AND PROJECTS

Postoperative radiochemotherapy slightly increases the hope of cure. In locally advanced tumors, radiochemotherapy, sometimes preoperative, allows some patients to survive more than two years. Though results of palliative chemotherapy remain very poor, some clinical benefit has been observed in randomized trials comparing this treatment with the currently best supportive treatment.