[Adjuvant treatment of cancer of the exocrine pancreas].

Survival at 5 years has been observed in 5 to 10 p. 100 of patients with cancer of the exocrine pancreas and lower biliary tract who underwent surgical resection. However, since radical surgery can only be performed in about one out of five patients, 98 p. 100 of patients with pancreatic cancer receive no more than a palliative treatment. Owing to the sombre prognosis of this type of cancer, special efforts are being made to discover new adjuvant treatments that will enhance the effects of curative or, more often, palliative treatments. These adjuvant treatments fall into three categories: chemotherapy, radiotherapy and hormonal therapy. Most trials have been carried out in cancers of the exocrine pancreas. The main criticism that can be raises against trials conducted in patients with cancer of the biliary tract is that none of them comprised an untreated control group, and in the absence of control group it is impossible to determine whether treatment really improved the patients' survival. This does not apply to trials conducted in patients with cancer of the endocrine pancreas: some trials included a control group chosen at random, whilst in other trials therapeutic effectiveness was judged on the "response rate". Yet an objective "response rate", as can be evaluated by such morphological examination as computerized tomography, is not synonymous with "therapeutic effectiveness", as the latter can only be asserted by an increase of survival. The authors described the adjuvant treatments that have been proposed for pancreatic cancer.