The risks of damage to the kidneys, spleen , liver, spinal cord and the bowel surrounding the pancreas can be minimized by careful treatment planning. 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), Adriamycin , mitomycin-C and streptozocin . 5-fluorouracil has had the best response but in no more than 20 percent of patients.
Various combinations such as FAM (5-FU + Adriamycin + mitomycin-C), SMF (streptozocin + mitomycin-C + 5-FU , 5-FU + platinol , and 5-FU + leucovorin + mitomycin-C + dipyridamole) may increase survival a few months and have had a good response in selected cases, but there is little proof that combination therapy is superior to 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 be bypassed
