Current status of chemoradiotherapy for locally advanced pancreatic cancer in Japan.

Although the results of randomized controlled trials for locally advanced pancreatic cancer conducted between 1969 and 1988 demonstrated a survival advantage for concurrent radiotherapy and bolus 5-fluorouracil (FU) injection, the prognosis of patients with this disease remains very poor. In an attempt to improve patient outcome after chemoradiotherapy, various clinical trials for this disease have been conducted in Japan. These trials were designed to evaluate novel chemotherapy regimens combined with conventional radiotherapy, or intensive radiotherapy in combination with chemotherapy. After gemictabine was shown to yield a better survival outcome than 5-FU in patients with advanced disease, this drug was investigated as a chemotherapeutic agent and/or radiosensitizer for locally advanced pancreatic cancer in a number of trials. S-1, a novel oral fluoropyrimidine derivative that appears promising for the treatment of metastatic disease, is also being intensively evaluated in Japan for the treatment of locally advanced pancreatic cancer. In this review, we summarize recent treatment strategies that are being used in Japan with the goal of establishing a new standard therapy for locally advanced pancreatic cancer.