BACKGROUND: Pancreatic cancer is among the deadliest tumors. Due to intrinsic chemo- and radio-resistance, surgical resection remains the only chance for cure. However surgery alone is unable to considerably improve survival and complementary chemotherapy and radiotherapy in a multimodal approach have been tested. Adjuvant chemotherapy yielded a modest outcome improvement, whereas the use of adjuvant chemoradiation is highly controversial. In this scenario, the neoadjuvant approach has a strong theoretical rationale, but limited information on the efficacy of this strategy is available. MATERIALS AND METHODS: This review critically overviews the current knowledge, the rationale, the available data and information on neoadjuvant treatment in resectable pancreatic cancer. RESULTS: The very early systemic dissemination of pancreatic cancer endorses the rationale for an up-front use of systemic therapy. However, evidence collected so far depends on retrospective data, small case series that did not balance the different characteristics of patients suitable for surgery before or after neoadjuvant chemotherapy. CONCLUSION: Currently there is no straightforward evidence to support the routine clinical use of this strategy. Only a properly designed randomized trial testing combination chemotherapy regimens selected on the basis of their efficacy and activity against metastatic disease can address this issue.
BACKGROUND:Pancreatic cancer is among the deadliest tumors. Due to intrinsic chemo- and radio-resistance, surgical resection remains the only chance for cure. However surgery alone is unable to considerably improve survival and complementary chemotherapy and radiotherapy in a multimodal approach have been tested. Adjuvant chemotherapy yielded a modest outcome improvement, whereas the use of adjuvant chemoradiation is highly controversial. In this scenario, the neoadjuvant approach has a strong theoretical rationale, but limited information on the efficacy of this strategy is available. MATERIALS AND METHODS: This review critically overviews the current knowledge, the rationale, the available data and information on neoadjuvant treatment in resectable pancreatic cancer. RESULTS: The very early systemic dissemination of pancreatic cancer endorses the rationale for an up-front use of systemic therapy. However, evidence collected so far depends on retrospective data, small case series that did not balance the different characteristics of patients suitable for surgery before or after neoadjuvant chemotherapy. CONCLUSION: Currently there is no straightforward evidence to support the routine clinical use of this strategy. Only a properly designed randomized trial testing combination chemotherapy regimens selected on the basis of their efficacy and activity against metastatic disease can address this issue.
Authors: Cristiana Pistol Tanase; Ana Iulia Neagu; Laura Georgiana Necula; Cristina Mambet; Ana-Maria Enciu; Bogdan Calenic; Maria Linda Cruceru; Radu Albulescu Journal: World J Gastroenterol Date: 2014-08-21 Impact factor: 5.742
Authors: Eileen M OʼReilly; Anna Perelshteyn; William R Jarnagin; Mark Schattner; Hans Gerdes; Marinela Capanu; Laura H Tang; Joseph LaValle; Corinne Winston; Ronald P DeMatteo; Michael DʼAngelica; Robert C Kurtz; Ghassan K Abou-Alfa; David S Klimstra; Maeve A Lowery; Murray F Brennan; Daniel G Coit; Diane L Reidy; T Peter Kingham; Peter J Allen Journal: Ann Surg Date: 2014-07 Impact factor: 12.969
Authors: Pranav Murthy; Mazen S Zenati; Amr I Al Abbas; Caroline J Rieser; Nathan Bahary; Michael T Lotze; Herbert J Zeh; Amer H Zureikat; Brian A Boone Journal: Ann Surg Oncol Date: 2019-12-02 Impact factor: 5.344
Authors: Kyong Joo Lee; Hong In Yoon; Moon Jae Chung; Jeong Youp Park; Seungmin Bang; Seung-Woo Park; Jin Sil Seong; Si Young Song Journal: Gut Liver Date: 2016-03 Impact factor: 4.519