Contemporary Review of Borderline Resectable Pancreatic Ductal Adenocarcinoma
Abstract
:1. Introduction
2. Definition of Borderline Resectable Disease
3. Current Treatment for Borderline Resectable Disease
3.1. Neoadjuvant Therapy
3.2. Radiation Therapy
3.3. Assessing Response to Neoadjuvant Therapy
3.4. Surgical Resection
4. Current Investigation in the Treatment of Borderline Resectable Disease
5. Conclusions
Author Contributions
Conflicts of Interest
References
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NCCN Definition | AHPBA/SSO/SSAT Consensus Definition | MD Anderson Modified Definition | IAP Consensus Definition | |
---|---|---|---|---|
Venous Involvement | Involvement of SMV or PV that distorts, narrows, or occludes the vein with suitable vessel proximal and distal allowing resection and replacement | Involvement of the SMV or PV with or without narrowing, or encasement of the SMV or PV without encasement of nearby arteries, or short segment occlusion from tumor encasement or thrombus allowing resection and reconstruction | Short segment occlusion of SMV, PV, or SMV-PV confluence amenable to vascular resection and reconstruction | Tumor contact of 180 degrees or more circumference or occlusion of the SMV, PV, or SMV-PV confluence that does not exceed the inferior border of the duodenum |
Arterial Involvement | Gastroduodenal involvement up to the hepatic artery with short segment encasement or direct abutment of the hepatic artery without extension to the celiac access | Gastroduodenal artery encasement up to hepatic artery with short segment encasement or abutment of the hepatic artery without extension to the celiac access | 180 degree or less circumference involvement of the SMA or celiac access or short segment abutment/encasement of the hepatic artery (typically origin of gastroduodenal artery) | Tumor contact of 180 degrees or less circumference of the SMA or celiac access without deformity or tumor contact of the common hepatic artery without abutting the proper hepatic artery or celiac access |
Biological | None | None | Concern for extrapancreatic disease (suspicious but non-diagnostic metastatic lesions or locoregional lymph node involvement) | Anatomically resectable PDAC suspicious for extrapancreatic disease (CA 19-9 of 500 units/mL or more or regional lymph node metastases on biopsy or PET-CT) |
Performance Status | None | None | Poor performance status (ECOG 3 or more) or significant medical comorbidities that preclude immediate surgery | Anatomically resectable PDAC with poor performance status (ECOG 2 or more) |
Study | Year | Pts | Status | Chemo | Resected (%) | Vein Resection (%) | Median Survival (months) All/R/UR | R0 (%) |
---|---|---|---|---|---|---|---|---|
Mehta | 2001 | 15 | Borderline | 5-FU | 60 | NA | NA/30/8 | 100 |
Massuco | 2006 | 28 | Borderline Unresectable | GemOx | 39 | 38 | 15/21/10 | 87 |
Small | 2008 | 39 | Resectable Borderline Unresectable | Gem/XRT | 33 | NA | 76% at 1 year | 94 |
Katz | 2008 | 160 | Borderline | Gem/XRT | 41 | 27 | NA/40/13 | 94 |
McClaine | 2010 | 29 | Borderline | Gem/XRT | 41 | 42 | NA/23.3/15.5 | 67 |
Patel | 2011 | 17 | Borderline | Gem/Tax Cape 5-FU/XRT | 64 | 22 | 15/NA/NA | 89 |
Stokes | 2011 | 40 | Borderline | Cape/XRT | 40 | 58 | 12/23/NA | 88 |
Takahashi | 2013 | 80 | Borderline | Gem/XRT/LP | 51 | NR | 34% at 5 years | 100 |
Christians | 2014 | 18 | Borderline | FOLFIRINOX Gem/XRT Cape/XRT | 67 | 83% | NA/NA/9.3 | 100 |
Rose | 2014 | 64 | Borderline | Gem/Tax | 48 | 48 | 23.6/NA/15.4 | 87 |
Blazer | 2015 | 43 | Borderline Unresectable | FOLFIRINOX GemOx/XRT | 51 | 18 | 21.2/NA/12.7 | 86 |
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Bonds, M.; Rocha, F.G. Contemporary Review of Borderline Resectable Pancreatic Ductal Adenocarcinoma. J. Clin. Med. 2019, 8, 1205. https://doi.org/10.3390/jcm8081205
Bonds M, Rocha FG. Contemporary Review of Borderline Resectable Pancreatic Ductal Adenocarcinoma. Journal of Clinical Medicine. 2019; 8(8):1205. https://doi.org/10.3390/jcm8081205
Chicago/Turabian StyleBonds, Morgan, and Flavio G. Rocha. 2019. "Contemporary Review of Borderline Resectable Pancreatic Ductal Adenocarcinoma" Journal of Clinical Medicine 8, no. 8: 1205. https://doi.org/10.3390/jcm8081205