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

Int Collaborative Grp Locally, TF Stoop, RT Theijse, LWF Seelen, BG Koerkamp, CHJ van Eijck, CL Wolfgang, G van Tienhoven, HC van Santvoort, IQ Molenaar, JW Wilmink, M Del Chiaro, MHG Katz, T Hackert, MG Besselink*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

13 Citations (Scopus)

Abstract

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.
Original languageEnglish
Pages (from-to)101-124
Number of pages24
JournalNature Reviews Gastroenterology and Hepatology
Volume21
Issue number2
Early online date30 Nov 2023
DOIs
Publication statusPublished - Feb 2024

Bibliographical note

Publisher Copyright:
© 2023, Springer Nature Limited.

Fingerprint

Dive into the research topics of 'Preoperative chemotherapy, radiotherapy and surgical decision-making in patients with borderline resectable and locally advanced pancreatic cancer'. Together they form a unique fingerprint.

Cite this