title: Systematic review on the treatment of isolated local recurrence of pancreatic cancer after surgery; re-resection, chemoradiotherapy and SBRT.
abstract: The majority of patients who have undergone a pancreatic resection for pancreatic cancer develop disease recurrence within two years. In around 30% of these patients, isolated local recurrence (ILR) is found. The aim of this study was to systematically review treatment options for this subgroup of patients.
  
  
  
  A systematic search was performed in PubMed, Embase and the Cochrane Library. Studies reporting on the treatment of ILR after initial curative-intent resection of primary pancreatic cancer were included. Primary endpoints were morbidity, mortality and survival after ILR treatment.
  
  
  
  After screening 1152 studies, 18 studies reporting on 313 patients undergoing treatment for ILR were included. Treatment options for ILR included surgical re-resection (8 studies, 100 patients), chemoradiotherapy (7 studies, 153 patients) and stereotactic body radiation therapy (SBRT) (4 studies, 60 patients). Morbidity and mortality were reported for re-resection (29% and 1%, respectively), chemoradiotherapy (54% and 0%) and SBRT (3% and 1%). Most patients had a prolonged disease-free interval before recurrence. Median survival after treatment of ILR of up to 32, 19 and 16 months was reported for re-resection, chemoradiotherapy and SBRT, respectively.
  
  
  
  In selected patients, treatment of ILR following pancreatic resection for pancreatic cancer seems safe, feasible and associated with relatively good survival.
authors.affiliation: Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands; Dept. of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Vincent P
authors.initials: VP
authors.lastname: Groot
authors.affiliation: Dept. of Surgery, St. Antonius Hospital Nieuwegein, The Netherlands; Dept. of Surgery, Academic Medical Center Amsterdam, The Netherlands.
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.affiliation: Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands.
authors.forename: Steffi J E
authors.initials: SJ
authors.lastname: Rombouts
authors.affiliation: Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hagendoorn
authors.affiliation: Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands.
authors.forename: Inne H M
authors.initials: IH
authors.lastname: Borel Rinkes
authors.affiliation: Dept. of Radiation Oncology, University Medical Center Utrecht Cancer Center, The Netherlands.
authors.forename: Marco
authors.initials: M
authors.lastname: van Vulpen
authors.affiliation: Dept. of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
authors.affiliation: Dept. of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.affiliation: Dept. of Surgery, Academic Medical Center Amsterdam, The Netherlands.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands. Electronic address: i.q.molenaar@umcutrecht.nl.
authors.forename: I Quintus
authors.initials: IQ
authors.lastname: Molenaar
mesh_terms: D059248:Chemoradiotherapy / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016634:Radiosurgery / Q000009:adverse effects / Q000401:mortality; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome