title: Neoadjuvant therapy in resectable pancreatic cancer: a critical review.
abstract: BACKGROUND
  Pancreatic cancer is among the deadliest tumors. Due to intrinsic chemo- and radio-resistance, surgical resection remains the only chance for cure. However surgery alone is unable to considerably improve survival and complementary chemotherapy and radiotherapy in a multimodal approach have been tested. Adjuvant chemotherapy yielded a modest outcome improvement, whereas the use of adjuvant chemoradiation is highly controversial. In this scenario, the neoadjuvant approach has a strong theoretical rationale, but limited information on the efficacy of this strategy is available.
  
  
  METHODS
  This review critically overviews the current knowledge, the rationale, the available data and information on neoadjuvant treatment in resectable pancreatic cancer.
  
  
  RESULTS
  The very early systemic dissemination of pancreatic cancer endorses the rationale for an up-front use of systemic therapy. However, evidence collected so far depends on retrospective data, small case series that did not balance the different characteristics of patients suitable for surgery before or after neoadjuvant chemotherapy.
  
  
  CONCLUSIONS
  Currently there is no straightforward evidence to support the routine clinical use of this strategy. Only a properly designed randomized trial testing combination chemotherapy regimens selected on the basis of their efficacy and activity against metastatic disease can address this issue.
authors.affiliation: Department of Medical Oncology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy. belli.carmen@hsr.it
authors.forename: Carmen
authors.initials: C
authors.lastname: Belli
authors.forename: Stefano
authors.initials: S
authors.lastname: Cereda
authors.forename: Santosh
authors.initials: S
authors.lastname: Anand
authors.forename: Michele
authors.initials: M
authors.lastname: Reni
mesh_terms: D006801:Humans; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery*