title: Borderline resectable pancreatic cancer: More than an anatomical concept.
abstract: Borderline resectable pancreatic cancer (BRPC) accounts for about 10-15% of newly diagnosed pancreatic cancer, and its management requires a skilled multidisciplinary team. The main definition of BRPC refers to resectability, but also a high risk of positive surgical margins and recurrence. This raises questions about the value of surgery and suggests an opportunity to utilize preoperative treatment in this subset of patients. Besides technical borderline resectable disease which is defined on anatomical and radiological criteria, there is also a biological borderline resectable disease which is defined on clinical and biological prognostic factors. Technical borderline resectable disease requires tumor shrinkage with aggressive therapy including modern drug combinations +/- radiotherapy to achieve radical surgery. Biological BRPC needs always an early systemic treatment in order to select the best candidates for subsequent radical surgery. It is important to distinguish between these different clinical scenarios, both in clinical practice and for clinical trials design.
authors.affiliation: Medical Oncology Unit, ASST Bergamo Ovest, Bergamo, Italy. Electronic address: faupe@libero.it.
authors.forename: Fausto
authors.initials: F
authors.lastname: Petrelli
authors.affiliation: Medical Oncology Unit, Sacro Cuore Don Calabria Hospital, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Inno
authors.affiliation: Medical Oncology Unit, ASST Bergamo Ovest, Bergamo, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Barni
authors.affiliation: Medical Oncology Unit, Casa di Cura Igea, Milano, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ghidini
authors.affiliation: Medical Oncology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Labianca
authors.affiliation: Surgical Department of Pancreas, San Raffaele Hospital, IRCCS, Milano, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
authors.affiliation: Medical Oncology Unit, San Raffaele Hospital, IRCCS, Milano, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Reni
authors.affiliation: Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cascinu
mesh_terms: D006801:Humans; D000072662:Margins of Excision; D020360:Neoadjuvant Therapy / Q000379:methods*; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic
keywords: Borderline resectable; Pancreatic cancer; Treatment