title: Ductal pancreatic adenocarcinoma.
abstract: BACKGROUND
  Ductal adenocarcinoma of the pancreas is the fourth most common cause of death from cancer in men and women in Germany: about 15 000 persons die of this disease each year.
  
  
  METHODS
  The S3 guideline on exocrine pancreatic carcinoma was updated with the aid of systematic literature reviews on the surgical, neoadjuvant, and adjuvant treatment of ductal pancreatic carcinoma, and on treatment in the metastatic stage. These reviews covered the periods 2002 to February 2012 (for radiotherapy) and 2006 to August 2011 (for all other topics).
  
  
  RESULTS
  The criteria for borderline resectable pancreatic tumors are the same as those of the guidelines of the National Comprehensive Cancer Network. Preoperative biliary drainage with a stent is recommended only if cholangitis is present or if a planned operation cannot be performed soon after the diagnosis is made. When a pancreatic carcinoma is resected, at least 10 regional lymph nodes should be excised, and the ratio of affected to excised nodes should be documented in the pathology report. Gemcitabine and 5-fluorouracil are recommended for adjuvant therapy. Neither of these drugs is preferred over the other; if the one initially given is poorly tolerated, the other one should be given instead. When gemcitabine and erlotinib are given for palliative treatment, erlotinib should be given for no longer than 8 weeks if no skin rash develops. In selected patients, the folfirinox protocol yields markedly better results than gemcitabin. Moreover, the new combination of nab-paclitaxel and gemcitabine can be used as first-line treatment. In the event of disease progression under first-line treatment, second-line treatment should be initiated.
  
  
  CONCLUSIONS
  In recent years, new chemotherapeutic protocols have brought about marked improvement in palliative care. Further trials are needed to determine whether the perioperative or adjuvant use of these protocols might also improve the outcome of surgical treatment with curative intent.
authors: Ulm University Hospital Medical Center, Department of Internal Medicine I, Medical Clinic III, Department of Hematology & Oncology, Großhadern Hospital, Ludwig-Maximilian-¬Universität, Munich, Institute of Pathology, Ruhr-University Bochum, Radiation and Tumor Clinic, University Hospital of Duisburg-Essen, Surgical Clinic at the St. Josef-Hospital, Ruhr-University Bochum.
authors: Thomas
authors: T
authors: Seufferlein
authors: Marc
authors: M
authors: Porzner
authors: Volker
authors: V
authors: Heinemann
authors: Andrea
authors: A
authors: Tannapfel
authors: Martin
authors: M
authors: Stuschke
authors: Waldemar
authors: W
authors: Uhl
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000628:therapy*; D059248:Chemoradiotherapy / Q000592:standards*; D005858:Germany; D006801:Humans; D010535:Laparoscopy / Q000592:standards; D008495:Medical Oncology / Q000592:standards; D010166:Palliative Care / Q000592:standards*; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000628:therapy*