Surgery After Response to Chemotherapy for Locally Advanced Pancreatic Ductal Adenocarcinoma: A Guide for Management
J Natl Compr Canc Netw . 2021 Apr 1;19(4):459-467. doi: 10.6004/jnccn.2021.7009. Print 2021 Apr.
Zhi Ven Fong, Cristina R Ferrone
Because of the biologic aggressiveness and late presentation of pancreatic ductal adenocarcinoma (PDAC), up to 80% of patients have locally advanced or metastatic disease at presentation. The success of multiagent chemotherapy regimens in the management of metastatic disease has been translated to patients with locally advanced PDAC. Both FOLFIRINOX (fluorouracil/folinic acid/irinotecan/oxaliplatin) and gemcitabine/nab-paclitaxel are used to downstage locally advanced PDAC to render it eligible for resection with curative intent. This paradigm shift has significantly expanded the pool of patients who are eligible for resection with curative intent. However, the generalizability of present studies and the patient selection process are unclear. This article provides an evidence-based review of patient selection considerations and management algorithms, and details our institution's approach to patients with locally advanced PDAC after preoperative chemotherapy.
Read Full Article Here: https://doi.org/10.6004/jnccn.2021.7009