Neoadjuvant Treatment for Borderline Resectable Pancreatic Ductal Adenocarcinoma.

Kaufmann, Benedikt; Hartmann, Daniel; D'Haese, Jan G; Stupakov, Pavel; Radenkovic, Dejan; Gloor, Beat; Friess, Helmut (2018). Neoadjuvant Treatment for Borderline Resectable Pancreatic Ductal Adenocarcinoma. (In Press). Digestive surgery, pp. 1-7. Karger 10.1159/000493466

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One of the main reasons for the dismal prognosis of pancreatic ductal adenocarcinoma (PDAC) is its late diagnosis. At the time of presentation, only approximately 15-20% of all patients with PDAC are considered resectable and around 30% are considered borderline resectable. A surgical approach, which is the only curative option, is limited in borderline resectable patients by local involvement of surrounding structures. In borderline resectable pancreatic cancer (BRPC), neoadjuvant treatment regimens have been introduced with the rationale to downstage and downsize the tumor in order to enable resection and eliminate -microscopic distant metastases. However, there are no official guidelines for the preoperative treatment of BRPC. In the majority of cases, patients are administered -Gemcitabine-based or FOLFIRINOX-based chemotherapy regimens with or without radiation. Radiologic restaging after neoadjuvant therapy has to be judged with caution when it comes to predict tumor response and resectability, since inflammation induced by neoadjuvant therapy may mimic solid tumor. Patients who do not show any disease progression during neoadjuvant therapy should be offered surgical exploration, since a high percentage is likely to undergo resection with negative margins (R0) and, thus, achieve improved overall survival although imaging judged it unlikely. Despite the promising new approaches of neoadjuvant treatment regimens during the last 2 decades, surgery remains the first choice if the tumor appears to be primary resectable at the time of diagnosis. At present, there are no international guidelines regarding the preoperative treatment of BRPC. Therefore, in order to standardize and adjust neoadjuvant treatment in the future, new guidelines have to be determined on the basis of upcoming prospective randomized studies.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery

UniBE Contributor:

Gloor, Beat

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0253-4886

Publisher:

Karger

Language:

English

Submitter:

Lilian Karin Smith-Wirth

Date Deposited:

19 Mar 2019 17:15

Last Modified:

20 Mar 2019 01:32

Publisher DOI:

10.1159/000493466

PubMed ID:

30408790

Uncontrolled Keywords:

Borderline resectable pancreatic cancer Neoadjuvant treatment Pancreatic ductal adenocarcinoma

BORIS DOI:

10.7892/boris.125773

URI:

https://boris.unibe.ch/id/eprint/125773

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