Combination radiotherapy and chemotherapy (5-fluorouracil or 5-fluorouracil + cisplatin) may offer a longer survival and palliation with decreased pain.
Intraoperative radiotherapy (IORT) and interstitial I-125 radioactive implants have helped local tumor control but have not increased survival.
Chemotherapy No major palliative role for chemotherapy has been proven. The most
commonly used drugs are 5-fluorouracil (5-FU), doxorubicin , mitomycin-C and streptozocin . 5-fluorouracil has had the best response but in no more than 20 percent of patients and the duration of response is short.
Various combinations such as FAM (5-FU + doxorubicin + mitomycin-C), SMF (streptozocin + mitomycin-C + 5-FU), 5-FU + cisplatin, and 5-FU + leucovorin + mitomycin-C + dipyridamole have failed to show meaningful benefit over 5-FU alone.
Some investigational protocols have added interferon or PALA to 5-FU and leucovorin, but the results are about the same. Better treatment needs to be developed.
Palliation Although surgery and radiation therapy will not improve survival, both may improve
the quality of life. A biliary tract obstructed by a tumor at the head of the pancreas can by bypassed
