Defining and Treating Borderline Resectable Pancreatic Cancer
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Upper Gastrointestinal Cancers (JD Berlin, Section Editor)
Defining and Treating Borderline Resectable Pancreatic Cancer Giampaolo Perri, MD Laura Prakash, MD Matthew H. G. Katz, MD* Address * Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT 17.6058, Unit 1484, Houston, TX, 77030, USA Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Upper Gastrointestinal Cancers Keywords Pancreatic cancer I Pancreatic adenocarcinoma I Borderline resectable I Preoperative therapy I Neoadjuvant therapy
Opinion statement Patients with borderline resectable pancreatic ductal adenocarcinoma (BR PDAC) should receive preoperative chemotherapy with or without radiation therapy, with the intent to eradicate occult metastatic cancer cells, to select patients with a “locally dominant cancer phenotype” for whom local therapies might be most effective, and to reduce the anatomic extent of tumors to facilitate surgical resection. The administration of preoperative therapy may also be a useful strategy to deliver the maximum load of chemotherapy to patients with BR PDAC, since as many as half of patients will never qualify for adjuvant treatments following pancreatectomy due to postoperative morbidity or disease progression. Patients with BR PDAC should be categorized at diagnosis on the basis of anatomical, biological, and conditional criteria and should be offered induction systemic chemotherapy with close monitoring for toxicity, followed by administration of (chemo)radiation in selected cases. Patients should be restaged after systemic therapy and, if used, (chemo)radiation. Patients who continue to show disease response or disease stability without signs of progression should be considered for pancreatectomy; better measures of response to therapy are needed.
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Curr. Treat. Options in Oncol.
(2020) 21:71
Introduction Pancreatic ductal adenocarcinoma (PDAC) is associated with a 5-year overall survival of less than 8% among all patients and is expected to become the second cause of cancer-related mortality in the USA within the next year [1, 2]. Despite representing the only potentially curative treatment, surgical resection is possible in less than 20% of patients. Approximately 60% of patients with PDAC have metastatic disease identified upon presentation; those with ostensibly localized cancers can be classified as having one of three distinct disease stages: resectable, unresectable (locally advanced), and borderline resectable (BR). BR PDAC has historically been considered to be represented by a technically removable primary tumor that involves the mesenteric vasculature to a limited
degree and that is therefore at high risk for a microscopically (R1)—or even macroscopically (R2)—incomplete resection. The definition of BR PDAC has evolved over time, however, and now incorporates other biological tumor and patient-related features which together indicate a
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