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Published on: February 1, 2020
Borderline resectable pancreatic cancer: conceptual evolution and current approach to image-based classification
J W Gilbert1,2,3, B Wolpin3,4, T Clancy3,5
1Department of Imaging, Dana-Farber Cancer Institute.
Summary
Defining borderline resectable pancreatic cancer using imaging criteria remains challenging due to a lack of consensus. Evolving radiological standards are crucial for guiding treatment and improving patient prognosis.
Area of Science:
- Radiology
- Oncology
- Surgical Oncology
Background:
- Diagnostic imaging is vital for pancreatic adenocarcinoma diagnosis and monitoring.
- Borderline resectable pancreatic cancer is a subset with increased risk of margin-positive resection due to vascular involvement.
Purpose of the Study:
- To review the evolution of borderline resectability concepts from a radiological viewpoint.
- To discuss imaging criteria, neoadjuvant therapy data, and current practices for borderline resectable pancreatic cancer.
Main Methods:
- Literature review focusing on radiological perspectives.
- Analysis of imaging criteria debates and classification systems.
- Examination of neoadjuvant therapy evidence and clinical practices.
Main Results:
- Neoadjuvant therapy may benefit borderline resectable pancreatic cancer patients, increasing R0 resection rates.
- Lack of universal agreement on imaging criteria and classification systems hinders consistent diagnosis and treatment.
- Small patient numbers and limited dedicated trials pose challenges for evidence-based management.
Conclusions:
- Awareness of evolving imaging criteria for borderline resectability is essential for clinicians and radiologists.
- These criteria significantly impact treatment strategies, follow-up, and patient prognosis.
- Standardization of diagnostic categorization and treatment selection is needed for this patient subset.
