ADJUVANT COMBINATION CHEMOTHERAPY (AMF) FOLLOWING RADICAL RESECTION OF CARCINOMA OF THE PANCREAS AND PAPILLA OF VATER - RESULTS OF A CONTROLLED, PROSPECTIVE, RANDOMIZED MULTICENTER STUDY

Between 1984 and 1987, 61 radically resected patients with carcinoma of the pancreas (n=47) or the papilla of Vater (n=14) were randomised either into postoperative adjuvant combination chemotherapy (AMF); 5-fluorouracil 500 mg/m2, doxorubicin 40 mg/m2, mitomycin C 6 mg/m2 (n=30) once every 3 weeks for six cycles, or into a control group (no adjuvant chemotherapy) (n=31). The median survival in the treatment group was 23 months compared with 11 months (P=0.02, median test) in the control group, dependant on a survival benefit in the treatment group during the initial 2 years (P=0.04 generalised Wilcoxon). The long-term prognosis was the same with an identical survival after 2 years (P=0.10, power=0.83). The observed 1, 2, 3 and 5-year survivals in the treatment group were 70, 43, 27 and 4% compared with 45, 32, 30 and 8 in the control group. 1 patient succumbed to sepsis probably attributable to chemotherapy. Cardiotoxicity and nephrotoxicity were recorded in 2 patients. These results suggest that adjuvant chemotherapy does postpone the incidence of recurrence in the first 2 years following radical surgery but increased cure rate was not observed.