Locally Advanced, Unresectable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline

Abstract

A multiphase computed tomography scan of the chest, abdomen, and pelvis should be performed. Baseline performance status and comorbidity profile should be evaluated. The goals of care, patient preferences, psychological status, support systems, and symptoms should guide decisions for treatments. A palliative care referral should occur at first visit. Initial systemic chemotherapy (6 months) with a combination regimen is recommended for most patients (for some patients radiation therapy may be offered up front) with Eastern Cooperative Oncology Group performance status 0 or 1 and a favorable comorbidity profile. There is no clear evidence to support one regimen over another. The gemcitabine-based combinations and treatments recommended in the metastatic setting (eg, fluorouracil, leucovorin, irinotecan, and oxaliplatin and gemcitabine plus nanoparticle albumin-bound paclitaxel) have not been evaluated in randomized controlled trials involving locally advanced, unresectable pancreatic cancer. If there is local disease progression after induction chemotherapy, without metastasis, then radiation therapy or stereotactic body radiotherapy may be offered also with an Eastern Cooperative Oncology Group performance status ≤ 2 and an adequate comorbidity profile. If there is stable disease after 6 months of induction chemotherapy but unacceptable toxicities, radiation therapy may be offered as an alternative. Patients with disease progression should be offered treatment per the ASCO Metastatic Pancreatic Cancer Treatment Guideline. Follow-up visits every 3 to 4 months are recommended. Additional information is available at www.asco.org/guidelines/LAPC and www.asco.org/guidelines/MetPC and www.asco.org/guidelineswiki.

Correlation of 18F-Fluorodeoxyglucose Positron Emission Tomography Parameters with Patterns of Disease Progression in Locally Advanced Pancreatic Cancer after Definitive Chemoradiotherapy

“…The application of conventionally fractionated CRT regimens and hypofractionated treatments, including stereotactic ablative radiotherapy, warrants further investigation. As chemotherapy remains the mainstay of therapy in LAPC [7], [18], repeating this study in patients who will receive chemotherapy as their first treatment may be of benefit – both to further explore the prognostic value of FDG-PET in these patients, but also as a means of directing clinical decisions.…”

SEOM Clinical Guideline for the treatment of pancreatic cancer (2016)

“…Complications of tumor growth may require decompression maneuvers of the digestive tract or bile duct prior to an active cancer treatment. This must always be accompanied by an appropriate treatment of symptomatic support, initiated at the time of diagnosis [16]. The initial approach is controversial.…”

Resection of pancreatic cancer in Europe and USA: an international large-scale study highlighting large variations

“…Large-scale investigations on surgical resection for PaC are rare 10. Using data from seven population-based and nine institution-based cancer registries, this large-scale study aimed to explore the application of surgical resection for PaC in various European countries and USA.…”