Abstract
Pancreatic cancer is the fourth leading cause of adult cancer mortality in the United States with an expected 44,030 incident cases and 37,660 deaths in 2011; it remains an unsolved health problem and, arguably, the solid tumor of greatest biologic complexity. Although operative resection offers the only opportunity for cure, "curative" resection is a modest treatment for this disease. Currently, complete resection (R0) is necessary but clearly not sufficient to achieve long-term survival in the majority of patients. Even among patients with early stage pancreatic cancer (stages I and II) in whom cross-sectional imaging demonstrates a resectable primary tumor without distant metastases, recurrent disease occurs in the majority of patients after potentially "curative" surgery. The clinical observation that almost all patients with biopsy-proven pancreatic adenocarcinoma have radiographically occult metastatic disease in distant sites remains the most compelling argument against a surgery-first strategy for this disease. Advances in operative and perioperative care have decreased the morbidity and mortality associated with pancreatic surgery, which has in turn increased the frequency and complexity of operations performed. Nevertheless, notwithstanding the extent of resection and lymphadenectomy, even when performed safely, the median survival for patients with pancreatic cancer treated with a surgery-first strategy has not changed since the mid-1980s. The inadequacy of resection alone and the inability to reliably deliver postoperative adjuvant therapy after such large operations has led to a more widespread interest in the application of nonsurgical systemic therapies and chemoradiation before pancreatectomy in an effort to improve survival-a basic principle of oncology that has been applied to all other high-risk solid tumors. Herein, we review the potential advantages and ongoing challenges of preoperative or neoadjuvant treatment sequencing in patients with resectable and borderline resectable pancreatic cancer.
Original language | English (US) |
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Title of host publication | Pancreatic Cancer, Cystic Neoplasms and Endocrine Tumors |
Subtitle of host publication | Diagnosis and Management |
Publisher | Wiley-Blackwell |
Pages | 103-119 |
Number of pages | 17 |
ISBN (Electronic) | 9781118307816 |
ISBN (Print) | 9780470673188 |
DOIs | |
State | Published - Apr 7 2015 |
Keywords
- Adjuvant chemotherapy
- Borderline resectable
- Neoadjuvant chemoradiotherapy
- Pancreatic cancer
ASJC Scopus subject areas
- General Medicine