title: Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline.
abstract: To provide evidence-based recommendations to oncologists and others on potentially curative therapy for patients with localized pancreatic cancer.
  
  
  
  ASCO convened a panel of medical oncology, radiation oncology, surgical oncology, palliative care, and advocacy experts and conducted a systematic review of literature from January 2002 to June 2015. Outcomes included overall survival, disease-free survival, progression-free survival, and adverse events.
  
  
  
  Nine randomized controlled trials met the systematic review criteria.
  
  
  
  A multiphase computed tomography scan of the abdomen and pelvis or magnetic resonance imaging should be performed for all patients to assess the anatomic relationships of the primary tumor and for the presence of intra-abdominal metastases. Baseline performance status, comorbidity profile, and goals of care should be evaluated and established. Primary surgical resection is recommended for all patients who have no metastases, appropriate performance and comorbidity profiles, and no radiographic interface between primary tumor and mesenteric vasculature. Preoperative therapy is recommended for patients who meet specific characteristics. All patients with resected pancreatic cancer who did not receive preoperative therapy should be offered 6 months of adjuvant chemotherapy in the absence of contraindications. Adjuvant chemoradiation may be offered to patients who did not receive preoperative therapy with microscopically positive margins (R1) after resection and/or who had node-positive disease after completion of 4 to 6 months of systemic adjuvant chemotherapy. Patients should have a full assessment of symptoms, psychological status, and social supports and should receive palliative care early. Patients who have completed treatment and have no evidence of disease should be monitored. Additional information is available at www.asco.org/guidelines/PCPC and www.asco.org/guidelineswiki.
authors.affiliation: Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Alok A
authors.initials: AA
authors.lastname: Khorana
authors.affiliation: Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Pamela B
authors.initials: PB
authors.lastname: Mangu
authors.affiliation: Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Jordan
authors.initials: J
authors.lastname: Berlin
authors.affiliation: Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Anitra
authors.initials: A
authors.lastname: Engebretson
authors.affiliation: Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Theodore S
authors.initials: TS
authors.lastname: Hong
authors.affiliation: Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Anirban
authors.initials: A
authors.lastname: Maitra
authors.affiliation: Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Supriya G
authors.initials: SG
authors.lastname: Mohile
authors.affiliation: Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Mumber
authors.affiliation: Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Richard
authors.initials: R
authors.lastname: Schulick
authors.affiliation: Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Marc
authors.initials: M
authors.lastname: Shapiro
authors.affiliation: Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Susan
authors.initials: S
authors.lastname: Urba
authors.affiliation: Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.affiliation: Alok A. Khorana and Marc Shapiro, Cleveland Clinic, Cleveland, OH; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Jordan Berlin, Vanderbilt University, Nashville, TN; Anitra Engebretson, Patient Representative, Portland, OR; Theodore S. Hong, Massachusetts General Hospital, Boston, MA; Anirban Maitra and Matthew H.G. Katz, The University of Texas MD Anderson Cancer Center, Houston, TX; Supriya G. Mohile, University of Rochester, Rochester, NY; Matthew Mumber, Harbin Clinic, Rome, GA; Richard Schulick, University of Colorado at Denver, Denver, CO; Susan Urba, University of Michigan, Ann Arbor, MI; and Herbert J. Zeh, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Matthew H G
authors.initials: MH
authors.lastname: Katz
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D008495:Medical Oncology; D010190:Pancreatic Neoplasms / Q000628:therapy*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012955:Societies, Medical