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

Abstract

Pancreatic cancer remains an aggressive disease with a 5 year survival rate of 5%. Only 15% of patients with pancreatic cancer are eligible for radical surgery. Evidence suggests a benefit on survival with adjuvant chemotherapy (gemcitabine o fluourouracil) after R1/R0 resection. Adjuvant chemoradiotherapy is also a valid option in patients with positive margins. Borderline resectable pancreatic cancer is defined as the involvement of the mesenteric vasculature with a limited extension. These tumors are technically resectable, but with a high risk of positive margins. Neoadjuvant treatment represents the best option for achieving an R0 resection. In advanced disease, two new chemotherapy treatment schemes (Folfirinox or Gemcitabine plus nab-paclitaxel) have showed improvements in overall survival compared with gemcitabine alone. Progress in pancreatic cancer treatment will require a better knowledge of the molecular biology of this disease, focusing on personalized cancer therapies in the near future.

Impact of the treatment of pancreatic exocrine insufficiency on survival of patients with unresectable pancreatic cancer: a retrospective analysis

“…Of the 53 patients in Group 2 receiving chemotherapy, 13 were initially considered unsuitable, but were later suitable and treated with chemotherapy after receiving other supportive therapies, including PERT. Chemotherapy regimens were selected following standard guidelines [ 31 ] according to age and performance status of the patients, and included gemcitabine monotherapy, gemcitabine-Nab-paclitaxel, folfirinox, and folfox. Sixty-seven patients were unfit for chemotherapy and only received best palliative clinical care.…”

“…Group 1 consisted of patients diagnosed with pancreatic cancer in the Department of Medical Oncology, General Surgery, or any department other than Gastroenterology, and who were treated according to well-accepted oncologic protocols [ 31 ]. Group 2 consisted of patients diagnosed with pancreatic cancer in the Department of Gastroenterology, and who were additionally followed-up at the Pancreas Unit of that Department and evaluated for symptoms of PEI, including significant weight loss (> 10% of body weight over less than 6 months before diagnosis), diarrhea and other maldigestion-related symptoms, and nutritional status.…”

Gemcitabine-Based Neoadjuvant Treatment in Borderline Resectable Pancreatic Ductal Adenocarcinoma: A Meta-Analysis of Individual Patient Data

“…To date no standard neoadjuvant protocol has been agreed in BR-PDAC ( 8 – 10 ). Palliative gemcitabine has been a standard of care in locally advanced or metastatic PDAC for many years and is used alone or in multi-agent combinations, and in association with radiotherapy ( 6 ).…”

Irreversible electroporation in borderline resectable pancreatic adenocarcinoma for margin accentuation

“…Achieving clear microscopic resection margins following PD is challenging particularly in BRPC with mesenteric vasculature involvement [ 4 , 10 ]. In view of the pressing need for optimal local disease control, irreversible electroporation (IRE) has emerged as a novel, non-thermal ablative therapy of pancreatic cancer [ 3 , 4 , 6 ].…”