Treatment of locoregional disease: adjuvant versus neoadjuvant

The efficacy of adjuvant therapy after the resection of pancreatic adenocarcinoma has been demonstrated by several randomized studies. Postoperative treatment applied either as chemotherapy alone or in combination with chemoradiotherapy is therefore considered a recommended standard in resectable pancreatic cancer (PC). Multiple arguments speak in favor of preoperative systemic therapy. Specifically, the conception of PC as a metastatic disease even at the early stage of apparent resectability supports the strategy of upfront systemic therapy. Unfortunately, randomized studies comparing neoadjuvant with adjuvant regimens have not been performed, and the superiority of one strategy over the other still has to be confirmed. Future clinical research may even combine neoadjuvant and adjuvant treatment. New avenues of individualized treatment may also be reached by the inclusion of molecular parameters of the tumor and pharmacogenomic profiles of the patient into decision making.