title: Multidisciplinary neoadjuvant management for potentially curable pancreatic cancer.
abstract: Pancreatic adenocarcinoma remains the fourth leading cause of cancer mortality in the U.S. Despite advances in surgical technique, radiotherapy technologies, and chemotherapeutics, the 5-year survival rate remains approximately 20% for the 15% of patients who are eligible for surgical resection. The majority of this group suffers metastatic recurrence. However, despite advances in therapies for patients with advanced pancreatic cancer, only surgery has consistently proven to improve long-term survival. Various combinations of chemotherapy, biologic-targeted therapy, and radiotherapy have been evaluated in different settings to improve outcomes. In this context, a neoadjuvant (preoperative) treatment strategy offers numerous potential benefits: (1) ensuring delivery of early, systemic therapy, (2) improving selection of patients for surgical therapy with truly localized disease, (3) potential downstaging of the neoplasm facilitating a negative margin resection in patients with locally advanced disease, and (4) providing a superior clinical trial mechanism capable of rapid assessment of the efficacy of novel therapeutics. This article reviews the recent trends in the management of pancreatic adenocarcinoma, with a particular emphasis on a multidisciplinary neoadjuvant approach to treatment.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Neelam V
authors.initials: NV
authors.lastname: Desai
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Sarunas
authors.initials: S
authors.lastname: Sliesoraitis
authors.affiliation: Department of Surgery, University of Florida, Gainesville, Florida.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hughes
authors.affiliation: Department of Surgery, University of Florida, Gainesville, Florida.
authors.forename: Jose G
authors.initials: JG
authors.lastname: Trevino
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, Florida.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Zlotecki
authors.affiliation: University of Florida Health Cancer Center, Gainesville, Florida.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Ivey
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: George
mesh_terms: D002986:Clinical Trials as Topic; D019468:Disease Management; D006801:Humans; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Chemotherapy; neoadjuvant; pancreatic cancer; personalized oncology; radiation; surgery