Adjuvant chemoradiotherapy in pancreatic adenocarcinoma--are we forcing a milestone?

Survival for pancreatic ductal adenocarcinoma is low and the role of adjuvant therapy remains controversial, with the European studies indicating survival benefit of chemotherapy over chemoradiation, whereas the American reports indicate an undoubted benefit with chemoradiation. Whatever is the mode of adjuvant care, two things are obvious in the management of this disease: surgery is the mainstay of treatment and a complete resection is the only hope of cure. Secondly, irrespective of the adjuvant treatment modality, survival advantage is limited and five-year survival has failed to reach that of other malignancies. The mixed results obtained from the various adjuvant therapy trials indicate that a uniform protocol is yet to be reached. A milestone is said to have been reached when a treatment or a treatment modality revolutionizes the outcome of a disease. As of now the adjuvant treatment in pancreatic adenocarcinoma is still evolving. Maybe a fresh look is needed at the biological aspect of the disease to add a new thought in its management, as has happened with other human malignancies.