title: Management of the Primary Tumor and  Limited Metastases in Patients With  Metastatic Pancreatic Cancer.
abstract: New combinations of cytotoxic chemotherapy have been proven to increase response rates and survival times compared with single-agent gemcitabine for patients with metastatic pancreatic cancer. These responses have been dramatic for a subset of patients, therefore raising questions about the management of limited metastatic disease with surgery or other ablative methods. Similarly, for patients having a complete radiographic response to chemotherapy in the metastatic compartment, whether to consider local therapy in the form of radiation or surgery for the primary tumor is now an appropriate question. Therefore, collaboration among experts in surgery, medical oncology, and radiation oncology has led to the development of guiding principles for local therapies to the primary intact pancreatic tumor for patients with limited metastatic disease and those who have had a significant response after systemic therapy.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
authors.forename: John P
authors.initials: JP
authors.lastname: Hoffman
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Thayer
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolff
mesh_terms: D003131:Combined Modality Therapy; D019468:Disease Management; D006801:Humans; D009362:Neoplasm Metastasis; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome