Management of borderline and locally advanced pancreatic cancer: where do we stand?
Many patients with pancreas cancer present with locally advanced pancreatic cancer (LAPC). The principle tools used for diagnosis and staging of LAPC include endoscopic ultrasound, axial imaging with computed tomography and magnetic resonance imaging, and diagnostic laparoscopy. The definition of resectability has historically been vague, as there is considerable debate and controversy as to the definition of LAPC. For the patient with LAPC, there is some level of involvement of the surrounding vascular structures, which include the superior mesenteric artery, celiac axis, hepatic artery, superior mesenteric vein, or portal vein. When feasible, most surgeons would recommend possible surgical resection for patients with borderline LAPC, with the goal of an R0 resection. For initially unresectable LAPC, neoadjuvant should be strongly considered. Specifically, these patients should be offered neoadjuvant therapy, and the tumor should be assessed for possible response and eventual resection. The efficacy of neoadjuvant therapy with this approach as a bridge to potential curative resection is broad, ranging from 3%-79%. The different modalities of neoadjuvant therapy include single or multi-agent chemotherapy combined with radiation, chemotherapy alone, and chemotherapy followed by chemotherapy with radiation. This review focuses on patients with LAPC and addresses recent advances and controversies in the field.
['He|Jin|J|', 'Page|Andrew J|AJ|', 'Weiss|Matthew|M|', 'Wolfgang|Christopher L|CL|', 'Herman|Joseph M|JM|', 'Pawlik|Timothy M|TM|']
D000971:Antineoplastic Combined Chemotherapy Protocols D059186:Chemoradiotherapy, Adjuvant D017024:Chemotherapy, Adjuvant D006801:Humans D008279:Magnetic Resonance Imaging D020360:Neoadjuvant Therapy D018365:Neoplasm, Residual D010180:Pancreatectomy D010190:Pancreatic Neoplasms D014057:Tomography, X-Ray Computed D016896:Treatment Outcome
Locally advanced Pancreatic cancer Pancreas Chemotherapy Radiation Irreversible electroporation