Defining and Treating Borderline Resectable Pancreatic Cancer

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Borderline resectable pancreatic ductal adenocarcinoma (BR PDAC) presents unique treatment challenges.
• Preoperative therapy is crucial for managing BR PDAC, aiming to improve surgical outcomes and patient survival.
• Current strategies focus on eradicating micrometastatic disease and selecting appropriate candidates for surgery.

Purpose of the Study:

• To outline a strategic approach for managing patients with borderline resectable pancreatic ductal adenocarcinoma.
• To emphasize the role of preoperative chemotherapy and chemoradiation in optimizing treatment.
• To define criteria for patient selection for pancreatectomy after neoadjuvant therapy.

Main Methods:

• Categorization of BR PDAC patients based on anatomical, biological, and conditional criteria at diagnosis.
• Administration of induction systemic chemotherapy with toxicity monitoring.
• Consideration of chemoradiation for selected cases.
• Restaging after neoadjuvant therapy to assess disease response or stability.

Main Results:

• Preoperative therapy aims to eradicate occult metastatic disease and downstage tumors.
• It allows for selection of patients with a 'locally dominant cancer phenotype' for effective local therapies.
• This strategy ensures maximum chemotherapy delivery, as many patients are ineligible for adjuvant treatment post-surgery.
• Patients demonstrating response or stability after neoadjuvant therapy are considered for pancreatectomy.

Conclusions:

• A multidisciplinary approach involving preoperative chemotherapy and potentially chemoradiation is recommended for BR PDAC.
• Patient categorization and restaging are critical for guiding treatment decisions and surgical candidacy.
• Further research is needed to develop better measures for assessing treatment response in BR PDAC.