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01-09-2016 | Review Article

Borderline resectable pancreatic cancer and the role of neoadjuvant chemoradiotherapy

Authors: Pierluigi di Sebastiano, Tommaso Grottola, F. Francesco di Mola

Published in: Updates in Surgery | Issue 3/2016

Abstract

Borderline resectable pancreatic cancer is now recognized as a distinct clinical entity. In these cases, neoadjuvant treatment could maximize the potential for an R0 resection and avoid R1/R2 resections. In fact, by analyzing, the current literature is evident that approximately one-third of initially borderline resectable pancreatic tumors may undergo successful resection following neoadjuvant therapy. However, the enormous difficulties in achieving a consensus and the variability in therapeutic algorithms have delayed progress in establishing strong evidence-based practices for diagnosis and treatment. In addition, the absence of a unique definition of borderline resectable pancreatic cancer remains a great obstacle for planning a therapeutic strategy and surgical decision-making. If on the one hand, we can finally say that the presence of only few prospective trials generates no strong data to support a specific neoadjuvant therapy regimen in borderline resectable pancreatic cancer, on the other hand, there are many studies on patients with borderline resectable pancreatic cancer who receive neoadjuvant therapy that can enjoy an R0 resection with similar outcomes to up-front resectable disease.

Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63:11–30CrossRefPubMed

Li D, Xie K, Wolff R, Abbruzzese JL (2004) Pancreatic cancer. Lancet 363:1049–1057CrossRefPubMed

Yeo CJ, Abrams RA, Grochow LB, Sohn TA, Ord SE, Hruban RH, Zahurak ML, Dooley WC, Coleman J, Sauter PK et al (1997) Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg 225:621–633 (discussion 633–636) CrossRefPubMedPubMedCentral

Yeo CJ, Cameron JL, Lillemoe KD, Sitzmann JV, Hruban RH, Goodman SN, Dooley WC, Coleman J, Pitt HA (1995) Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients. Ann Surg 221:721–731 (discussion 731–733) CrossRefPubMedPubMedCentral

Neoptolemos JP, Stocken DD, Bassi C, Ghaneh P, Cunningham D, Goldstein D, Padbury R, Moore MJ, Gallinger S, Mariette C et al (2010) Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA 304:1073–1081CrossRefPubMed

Gillen S, Shuster T, Meyer zum Buschenfelde C et al (2010) Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med 7:1–15CrossRef

Lopez NE, Prendergast C, Lowy AM (2014) Borderline resectable pancreatic cancer: definitions and management. World J Gastroenterol 20(31):10740–10751CrossRefPubMedPubMedCentral

Spitz FR, Abbruzzese JL, Lee JE, Pisters PW, Lowy AM, Fenoglio CJ, Cleary KR, Janjan NA, Goswitz MS, Rich TA et al (1997) Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas. J Clin Oncol 15:928–937PubMed

Schwarz L, Katz MH et al (2015) Diagnosis and management of borderline resectable pancreatic adenocarcinoma. Hematol Oncol Clin North Am 29(4):727–740CrossRefPubMed

10.

National comprehensive cancer network practice guidelines in oncology for pancreatic adenocarcinoma-v. 1. November 2008. http://www.nccn.org. Accessed 26 July 2016

11.

Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, Lee JE, Pisters PW, Evans DB, Wolff RA (2006) Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 13:1035–1046CrossRefPubMed

12.

Callery MP, Chang KJ, Fishman EK, Talamonti MS, William Traverso L, Linehan DC (2009) Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol 16:1727–1733CrossRefPubMed

13.

Tran Cao HS, Balachandran A, Wang H, Nogueras-González GM, Bailey CE, Lee JE, Pisters PW, Evans DB, Varadhachary G, Crane CH et al (2014) Radiographic tumor-vein interface as a predictor of intraoperative, pathologic, and oncologic outcomes in resectable and borderline resectable pancreatic cancer. J Gastrointest Surg 18:269–278 (discussion 278) CrossRefPubMed

14.

Katz MH, Marsh R, Herman JM, Shi Q, Collison E, Venook AP, Kindler HL, Alberts SR, Philip P, Lowy AM et al (2013) Borderline resectable pancreatic cancer: need for standardization and methods for optimal clinical trial design. Ann Surg Oncol 20:2787–2795CrossRefPubMed

15.

Marinelli T, Filippone A, Tavano F, Fontana A, Pellegrini F, Köninger J, Richter GM, Bonomo L, Büchler MW, di Sebastiano P, di Mola FF (2014) A tumour score with multidetector spiral CT for venous infiltration in pancreatic cancer: influence on borderline resectable. Radiol Med 119(5):334–342PubMed

16.

Bockhorn M, Uzunoglu FG, Adham M, for the International Study Group of Pancreatic Surgery et al (2014) Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery. Surgery 155:977–988CrossRefPubMed

17.

Abrams RA, Lowy AM, Em O’Reilly, Wolff RA, Picozzi VJ, Pisters PW (2009) Combined modality treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol 16:1751–1756CrossRefPubMed

18.

Pisters PW, Abbruzzese JL, Janjan NA, Cleary KR, Charnsangavej C, Goswitz MS, Rich TA, Raijman I, Wolff RA, Lenzi R et al (1998) Rapid-fractionation preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for resectable pancreatic adenocarcinoma. J Clin Oncol 16:3843–3850PubMed

19.

Yeung RS, Weese JL, Hoffman JP, Solin LJ, Paul AR, Engstrom PF, Litwin S, Kowalyshyn MJ, Eisenberg BL (1993) Neoadjuvant chemoradiation in pancreatic and duodenal carcinoma. A phase II study. Cancer 72:2124–2133CrossRefPubMed

20.

Stokes JB, Nolan NJ, Stelow EB, Walters DM, Weiss GR, de Lange EE, Rich TA, Adams RB, Bauer TW (2011) Preoperative capecitabine and concurrent radiation for borderline resectable pancreatic cancer. Ann Surg Oncol 18:619–627CrossRefPubMed

21.

Katz MH, Pisters PW, Evans DB, Sun CC, Lee JE, Fleming JB, Vauthey JN, Abdalla EK, Crane CH, Wolff RA, Varadhachary GR, Hwang RF (2008) Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg 206(5):833–846CrossRefPubMed

22.

Andriulli A, Festa V, Botteri E, Valvano MR, Koch M, Bassi C, Maisonneuve P, Di Sebastiano P (2012) Neoadjuvant/preoperative Gemcitabine for patints with localized pancreatic cancer: a meta-analysis of prospective studies. Ann Surg Oncol 19:1644–1662CrossRefPubMed

23.

Lim KH, Chung E, Khan A, Cao D, Linehan D, Ben-Josef E, Wang-Gillam A (2012) Neoadjuvant therapy of pancreatic cancer: the emerging paradigm? Oncologist 17(2):192–200CrossRefPubMedPubMedCentral

24.

Conroy T, Gavoille C, Samalin E, Ychou M, Ducreux M (2013) The role of the FOLFIRINOX regimen for advanced pancreatic cancer. Curr Oncol Rep 15(2):182–189CrossRefPubMed

25.

Boone BA, Steve J, Krasinskas AM, Zureikat AH, Lembersky BC, Gibson MK, Stoller RG, Zeh HJ, Bahary N (2013) Outcomes with FOLFIRINOX for borderline resectable and locally unresectable pancreatic cancer. J Surg Oncol 108(4):236–241CrossRefPubMed

26.

Katz MH, Fleming JB, Bhosale P, Varadhachary G, Lee JE, Wolff R, Wang H, Abbruzzese J, Pisters PW, Vauthey JN et al (2012) Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer 118:5749–5756CrossRefPubMed

27.

Ferrone CR, Marchegiani G, Hong TS, Ryan DP, Deshpande V, McDonnell EI, Sabbatino F et al (2015) Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg 261(1):12–17CrossRefPubMedPubMedCentral

28.

Araujo RL, Gaujoux S, Huguet F, Gonen M, D’Angelica MI, Dematteo RP, Fong Y, Kingham TP, Jarnagin WR, Goodman KA, Allen PJ (2013) Does pre-operative chemoradiation for initially unresectable or borderline resectable pancreatic adenocarcinoma increase post-operative morbidity? A case-matched analysis. HPB (Oxford) 15(8):574–580CrossRef

Title: Borderline resectable pancreatic cancer and the role of neoadjuvant chemoradiotherapy
Authors: Pierluigi di Sebastiano
Tommaso Grottola
F. Francesco di Mola
Publication date: 01-09-2016
Publisher: Springer Milan
Published in: Updates in Surgery / Issue 3/2016
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-016-0392-x

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Borderline resectable pancreatic cancer and the role of neoadjuvant chemoradiotherapy

Abstract

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Abstract

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