Abstract
Thanks to the development of modern chemotherapeutic regimens, survival after surgery for pancreatic ductal adenocarcinoma (PDAC) has improved and pancreatologists worldwide agree that the treatment of PDAC demands a multidisciplinary approach. Neoadjuvant treatment (NAT) plays a major role in the treatment of PDAC since only about 20% of patients are considered resectable at the time of diagnosis. Moreover, increasing data demonstrating the benefits of NAT for borderline resectable/locally advanced PDAC are driving a shift from up-front surgery to NAT in the multidisciplinary treatment of even resectable PDAC. Our understanding of the role of NAT in PDAC has evolved from tumor shrinkage to controlling potential micrometastases and selecting patients who may benefit from radical resection. The present review gives an overview on the current literature of NAT concepts for BR/LA PDAC and resectable PDAC.
Highlights
The role of neoadjuvant treatment (NAT) in pancreatic adenocarcinoma (PDAC) is still under debate due to a relative lack of robust data compared with other gastrointestinal cancers, in which the role of Neoadjuvant treatment (NAT) is more well-defined
The surgical complication rate was feasible at 38.2% and mortality rate was low at 2.9% [33]. These favorable results can be attributed to improved surgical skills and perioperative management, and to modern chemotherapeutics controlling potential micrometastases and selecting patients who may benefit from radical resection after NAT [33]
Thanks to the development of modern chemotherapeutic regimens, survival after surgery for pancreatic ductal adenocarcinoma (PDAC) has improved and pancreatologists worldwide believe that the treatment of PDAC demands a multidisciplinary approach
Summary
The role of neoadjuvant treatment (NAT) in pancreatic adenocarcinoma (PDAC) is still under debate due to a relative lack of robust data compared with other gastrointestinal cancers, in which the role of NAT is more well-defined. These encouraging data reported in recent years has led to an increasing number of patients treated with NAT using FOLFIRINOX and GnP regimens, even in resectable disease. The addition of radiotherapy does not appear to make a significant difference in resectability rates and survival (refer to tables), these results are primarily from retrospective studies and may be biased, as patients who received radiation may have had more advanced disease.
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