title: Neoadjuvant strategies for pancreatic cancer.
abstract: Pancreatic cancer (PC) is the fourth cause of cancer death in Western countries, the only chance for long term survival is an R0 surgical resection that is feasible in about 10%-20% of all cases. Five years cumulative survival is less than 5% and rises to 25% for radically resected patients. About 40% has locally advanced in PC either borderline resectable (BRPC) or unresectable locally advanced (LAPC). Since LAPC and BRPC have been recognized as a particular form of PC neoadjuvant therapy (NT) has increasingly became a valid treatment option. The aim of NT is to reach local control of disease but, also, it is recognized to convert about 40% of LAPC patients to R0 resectability, thus providing a significant improvement of prognosis for responding patients. Once R0 resection is achieved, survival is comparable to that of early stage PCs treated by upfront surgery. Thus it is crucial to look for a proper patient selection. Neoadjuvant strategies are multiples and include neoadjuvant chemotherapy (nCT), and the association of nCT with radiotherapy (nCRT) given as either a combination of a radio sensitizing drug as gemcitabine or capecitabine or and concomitant irradiation or as upfront nCT followed by nRT associated to a radio sensitizing drug. This latter seem to be most promising as it may select patients who do not go on disease progression during initial treatment and seem to have a better prognosis. The clinical relevance of nCRT may be enhanced by the application of higher active protocols as FOLFIRINOX.
authors: Francesco Polistina, Giuseppe Di Natale, Mauro Frego, Department of General Surgery, Monselice Hospital, 35043 Monselice, Italy.
authors: Francesco
authors: F
authors: Polistina
authors: Francesco Polistina, Giuseppe Di Natale, Mauro Frego, Department of General Surgery, Monselice Hospital, 35043 Monselice, Italy.
authors: Giuseppe
authors: G
authors: Di Natale
authors: Francesco Polistina, Giuseppe Di Natale, Mauro Frego, Department of General Surgery, Monselice Hospital, 35043 Monselice, Italy.
authors: Giorgio
authors: G
authors: Bonciarelli
authors: Francesco Polistina, Giuseppe Di Natale, Mauro Frego, Department of General Surgery, Monselice Hospital, 35043 Monselice, Italy.
authors: Giovanni
authors: G
authors: Ambrosino
authors: Francesco Polistina, Giuseppe Di Natale, Mauro Frego, Department of General Surgery, Monselice Hospital, 35043 Monselice, Italy.
authors: Mauro
authors: M
authors: Frego
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D006801:Humans; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018579:Patient Selection; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Chemoradiation; Chemotherap; Neoadjuvant; Pancreatic cancer; Radiotherapy