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Preoperative chemotherapy, radiotherapy and surgical decision-making in patients with borderline resectable and locally advanced pancreatic cancer

Surgical resection combined with systemic chemotherapy is the cornerstone of treatment for patients with localized pancreatic cancer. Upfront surgery is considered suboptimal in cases with extensive vascular involvement, which can be classified as either borderline resectable pancreatic cancer or lo...

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Main Authors: Stoop, Thomas F. (Author) , Theijse, Rutger T. (Author) , Seelen, Leonard W. F. (Author) , Groot Koerkamp, Bas (Author) , van Eijck, Casper H. J. (Author) , Wolfgang, Christopher L. (Author) , van Tienhoven, Geertjan (Author) , van Santvoort, Hjalmar C. (Author) , Molenaar, I. Quintus (Author) , Wilmink, Johanna W. (Author) , Del Chiaro, Marco (Author) , Katz, Matthew H. G. (Author) , Hackert, Thilo (Author) , Besselink, Marc G. (Author)
Format: Article (Journal)
Language:English
Published: February 2024
In: Nature reviews. Gastroenterology & hepatology
Year: 2024, Volume: 21, Issue: 2, Pages: 101-124
ISSN:1759-5053
DOI:10.1038/s41575-023-00856-2
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1038/s41575-023-00856-2
Verlag, lizenzpflichtig, Volltext: https://www.nature.com/articles/s41575-023-00856-2
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Author Notes:Thomas F. Stoop, Rutger T. Theijse, Leonard W. F. Seelen, Bas Groot Koerkamp, Casper H. J. van Eijck, Christopher L. Wolfgang, Geertjan van Tienhoven, Hjalmar C. van Santvoort, I. Quintus Molenaar, Johanna W. Wilmink, Marco Del Chiaro, Matthew H. G. Katz, Thilo Hackert, Marc G. Besselink & International Collaborative Group on Locally Advanced Pancreatic Cancer
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Summary:Surgical resection combined with systemic chemotherapy is the cornerstone of treatment for patients with localized pancreatic cancer. Upfront surgery is considered suboptimal in cases with extensive vascular involvement, which can be classified as either borderline resectable pancreatic cancer or locally advanced pancreatic cancer. In these patients, FOLFIRINOX or gemcitabine plus nab-paclitaxel chemotherapy is currently used as preoperative chemotherapy and is eventually combined with radiotherapy. Thus, more patients might reach 5-year overall survival. Patient selection for chemotherapy, radiotherapy and subsequent surgery is based on anatomical, biological and conditional parameters. Current guidelines and clinical practices vary considerably regarding preoperative chemotherapy and radiotherapy, response evaluation, and indications for surgery. In this Review, we provide an overview of the clinical evidence regarding disease staging, preoperative therapy, response evaluation and surgery in patients with borderline resectable pancreatic cancer or locally advanced pancreatic cancer. In addition, a clinical work-up is proposed based on the available evidence and guidelines. We identify knowledge gaps and outline a proposed research agenda.
Item Description:Online verfügbar: 30. November 2023
Gesehen am 07.02.2024
Physical Description:Online Resource
ISSN:1759-5053
DOI:10.1038/s41575-023-00856-2

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