The past, present, and future status of multimodality treatment for resectable/borderline resectable pancreatic ductal adenocarcinoma

Abstract

A multimodal approach to treating pancreatic ductal adenocarcinoma (PDAC) is now widely accepted. Improvements in radiological assessment have enabled us to define resectability in detail. Multimodality treatment is essential for patients, especially for those with PDAC in the borderline resectable (BR) stage. Even for disease in a resectable (R) stage, adjuvant and neoadjuvant therapies have demonstrated beneficial outcomes in several trials and analyses. Thus, there is growing interest in optimization of the perioperative therapeutic strategy. We discuss the transition of resectability criteria and the global standard of adjuvant and neoadjuvant treatments for patients with R/BR-PDAC.

Annual report to the nation on the status of cancer, part 1: National cancer statistics

“…21 There have also been improvements in multimodality therapy for pancreatic adenocarcinoma, which have shown a small survival benefit. 22 Emerging data about the efficacy of neoadjuvant chemoradiotherapy followed by surgery and chemotherapy have shown improved 5-year overall survival compared with surgery followed by chemotherapy. 23 Nonetheless, progress in treating pancreatic adenocarcinoma has been incremental at best, as demonstrated by the modest gains in survival over time.…”

Impact of resection margin status on survival after operation for pancreatic head cancer with extrapancreatic nerve plexus invasion

“…Multidisciplinary therapy for patients with PDAC is currently being developed 34 . Clinical trials have shown that adjuvant chemotherapy prolongs survival after operation for PDAC 11,12 .…”

“…33 Multidisciplinary therapy for patients with PDAC is currently being developed. 34 Clinical trials have shown that adjuvant chemotherapy prolongs survival after operation for PDAC. 11,12 We also demonstrated that the completion of adjuvant chemotherapy was identified as an independent prognostic factor in this study.…”

A scan of all coding region variants of the human genome, identifies 13q12.2-rs9579139 and 15q24.1-rs2277598 as novel risk loci for pancreatic ductal adenocarcinoma

“…Although the survival of the patients has increased in the last years, PDAC is characterized by comparable incidence and mortality rates, with a 5-year survival after diagnosis around 9% (3). The low survival rate is due to the difficult diagnosis at early stages, resulting in only one fifth of the patients amenable to surgical treatment (4,5). To date, a handful of high penetrance mutations have been associated with increased PDAC risk through family-based studies (3,6).…”