Perioperative Therapy for Borderline Resectable Pancreatic Cancer: What and When?

Excerpt

Over recent years, multidisciplinary teams have increasingly treated patients with borderline resectable pancreatic cancer (BRPC) with chemotherapy and/or radiation before anticipated pancreatectomy. The goal of preoperative treatment remains largely twofold: (1) to downsize the size of tumor and its involvement with adjacent anatomic structures, thereby maximizing the likelihood of a microscopically complete (R0) resection, and (2) to identify patients with pancreatic tumors exhibiting a “locally dominant phenotype”—tumors at low risk for rapid progression and recurrence—for whom pancreatectomy may be most beneficial. Although this strategy is recommended in national treatment guidelines, no clinical trial has prospectively randomized patients to either preoperative therapy or surgery de novo, and data supporting this approach have largely been derived from relatively small, retrospective series.1‐3 The optimal treatment algorithm for patients with BRPC therefore remains a matter of significant debate.4 …