Localized Pancreatic Cancer: Multidisciplinary Management

Area of Science:

• Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Pancreatic cancer has a poor prognosis with high mortality rates.
• Most patients are diagnosed with unresectable disease due to advanced vascular invasion or metastasis.
• Current treatment focuses on improving resectability and survival outcomes.

Purpose of the Study:

• To review current treatment strategies for pancreatic cancer, focusing on improving surgical resectability.
• To discuss the role of neoadjuvant therapies, including chemotherapy and radiation, in managing locally advanced disease.
• To highlight the importance of multidisciplinary tumor boards and biomarker research in optimizing patient selection and treatment.

Main Methods:

• Review of neoadjuvant chemotherapy regimens like FOLFIRINOX and gemcitabine/nab-paclitaxel.
• Evaluation of chemoradiotherapy and novel radiation techniques such as stereotactic body frame radiation therapy (SBRT).
• Discussion of patient selection through multidisciplinary tumor boards and ongoing biomarker discovery efforts.

Main Results:

• Neoadjuvant therapies improve response rates and survival in metastatic and locally advanced pancreatic cancer.
• Downstaging tumors with neoadjuvant treatment can enable margin-negative resection.
• Patients initially deemed unresectable may achieve survival comparable to resectable cases if they undergo surgery.

Conclusions:

• Advancements in neoadjuvant chemotherapy and radiation enhance the resectability of locally advanced pancreatic cancer.
• Surgical resection remains the only curative option, and achieving it, even after neoadjuvant therapy, is crucial for survival.
• Further research, including long-term follow-up and clinical trials, is essential to refine treatment strategies and improve outcomes for pancreatic cancer patients.