Neoadjuvant Therapy of Pancreatic Cancer: The Emerging Paradigm?

After completing this course, the reader will be able to: Discuss the current literature on the neoadjuvant therapies in patients with potentially resectable and borderline resectable pancreatic cancer. Cite the definition of borderline resectable pancreatic cancer as determined by the 2008 AHPBA consensus guidelines.This article is available for continuing medical education credit at CME.TheOncologist.com Pancreatic cancer remains one of the deadliest cancers due to difficulty in early diagnosis and its high resistance to chemotherapy and radiation. It is now clear that even patients with potentially resectable disease require multimodality treatment including chemotherapy and/or radiation to improve resectability and reduce recurrence. Tremendous efforts are currently being invested in refining preoperative staging to identify optimal surgical candidates, and also in developing various neoadjuvant or adjuvant regimens to improve surgical outcome. Although at present no studies have been done to directly compare the benefit of neoadjuvant versus adjuvant approaches, accumulating evidence suggests that the neoadjuvant approach is probably beneficial for a subset of the patient population, particularly those with borderline resectable disease in which complete surgical resection is almost certainly unachievable. In this article, we review the literature and rationales of neoadjuvant chemotherapy and chemoradiation, as well as their potential limitations and caveats. We also review the pathological findings following neoadjuvant therapies, and potential surgical complications that may be associated with neoadjuvant therapies.