title: Multimodal treatment of resectable pancreatic ductal adenocarcinoma.
abstract: After a timing preoperative staging, treatment of resectable pancreatic adenocarcinoma (PDAC) includes surgery and adjuvant therapies, the former representing the initial therapeutic option and the latter aiming to reduce the incidence of both distant metastases (chemotherapy) and locoregional failures (chemoradiotherapy). Herein, we provide a critical overview on the role of multimodal treatment in PDAC and on new opportunities related to current more active poli-chemotherapy regimens, targeted therapies, and the more recent immunotherapy approaches. Moreover, an analysis of pathological markers and clinical features able to help clinicians in the selection of the best therapeutic strategy will be discussed. Lastly, the role of neoadjuvant treatment of initially resectable disease will be considered mostly in patients whose malignancy shows morphological but not clinical or biological criteria of resectability. Depending on the results of these investigational studies, today a multidisciplinary approach can offer the best address therapy for these patients.
authors.affiliation: Medical Oncology Unit, Cancer Institute "Giovanni Paolo II", Bari, Italy. Electronic address: n.silvestris@oncologico.bari.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Silvestris
authors.affiliation: Medical Oncology Unit, Cancer Institute "Giovanni Paolo II", Bari, Italy. Electronic address: dr.oronzo.brunetti@tiscali.it.
authors.forename: Oronzo
authors.initials: O
authors.lastname: Brunetti
authors.affiliation: Department of Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. Electronic address: e.vasile@ao.pisa.toscana.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vasile
authors.affiliation: Radiation Oncology Department, Gemelli ART, Università Cattolica del Sacro Cuore, Roma, Italy. Electronic address: francesco.cellini@uniroma3.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cellini
authors.affiliation: ARC-NET Research Centre, University of Verona, Verona, Italy. Electronic address: cataldo.ivana@gmail.com.
authors.forename: Ivana
authors.initials: I
authors.lastname: Cataldo
authors.affiliation: Medical Oncology Unit, University of Cagliari, Cagliari, Italy. Electronic address: oncologiamedica2reparto@gmail.com.
authors.forename: Valeria
authors.initials: V
authors.lastname: Pusceddu
authors.affiliation: Department of Medical Oncology, University and General Hospital, Udine, Italy. Electronic address: aprile83@gmail.com.
authors.forename: Monica
authors.initials: M
authors.lastname: Cattaneo
authors.affiliation: Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy. Electronic address: partelli.stefano@hsr.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Partelli
authors.affiliation: Medical Oncology Unit, University of Cagliari, Cagliari, Italy. Electronic address: marioscartozzi@gmail.com.
authors.forename: Mario
authors.initials: M
authors.lastname: Scartozzi
authors.affiliation: Department of Medical Oncology, University and General Hospital, Udine, Italy; Department of Medical Oncology, General Hospital of Vicenza, Vicenza, Italy. Electronic address: aprile.giuseppe@aoud.sanita.fvg.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aprile
authors.affiliation: Medical Oncology Unit, IRCCS, Meldola, Italy. Electronic address: casadeigardini@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Casadei Gardini
authors.affiliation: Radiation Oncology Center, Dept. of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Italy. Electronic address: alessio.morganti2@unibo.it.
authors.forename: Alessio Giuseppe
authors.initials: AG
authors.lastname: Morganti
authors.affiliation: Radiation Oncology Department, Gemelli ART, Università Cattolica del Sacro Cuore, Roma, Italy. Electronic address: vincenzo.valentini@unicatt.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.affiliation: ARC-NET Research Centre, University of Verona, Verona, Italy. Electronic address: aldo.scarpa@univr.it.
authors.forename: Aldo
authors.initials: A
authors.lastname: Scarpa
authors.affiliation: Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy. Electronic address: falconi.massimo@hsr.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
authors.affiliation: Radiology Unit, Cancer Institute "Giovanni Paolo II", Bari, Italy. Electronic address: acalabrese22@gmail.com.
authors.forename: Angela
authors.initials: A
authors.lastname: Calabrese
authors.affiliation: Medical Oncology Unit, Cancer Institute "Giovanni Paolo II", Bari, Italy. Electronic address: vito.lorusso@oncologico.bari.it.
authors.forename: Vito
authors.initials: V
authors.lastname: Lorusso
authors.affiliation: Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: reni.michele@hsr.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Reni
authors.affiliation: Modena Cancer Center, Policlinico di Modena Università di Modena e Reggio Emilia, Italy. Electronic address: cascinu@yahoo.com.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cascinu
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D007167:Immunotherapy; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
keywords: Adjuvant; Chemotherapy; Pancreatic ductal adenocarcinoma; Radiotherapy; Target therapy