Borderline Resectable Pancreatic Cancer: Challenges for Clinical Management

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Pancreatic ductal adenocarcinoma (PDAC) is a major global health concern with a poor prognosis.
• Borderline resectable PDAC (BR-PDAC) involves limited vascular involvement, posing a high risk of positive resection margins (R1).

Purpose of the Study:

• To identify current challenges in the management of BR-PDAC.
• To review existing definitions and treatment strategies for BR-PDAC.

Main Methods:

• A comprehensive literature review was conducted.
• Articles discussing BR-PDAC definitions and management were identified and analyzed.

Main Results:

• Heterogeneity exists in BR-PDAC definitions and their application in clinical trials.
• Neoadjuvant chemotherapy, with or without radiation, is preferred for R0 resection, with modern regimens like FOLFIRINOX showing promise over older gemcitabine-based ones.
• Challenges include accurately restaging patients post-neoadjuvant therapy and defining the role of adjuvant therapy.

Conclusions:

• Optimal management of BR-PDAC remains uncertain despite advancements.
• There is a critical need for Phase III trials using modern chemotherapeutic regimens to establish a standard of care for BR-PDAC.