Bernhard W Renz1,2, Stefan Boeck2,3, Falk Roeder2,4,5, Christoph Trumm6, Volker Heinemann2,3, Jens Werner1,2. 1. Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich, Munich, Germany, Munich, Germany. 2. Pancreatic Cancer Center Munich, Comprehensive Cancer Center-LMU, University of Munich, Munich, Germany, Munich, Germany. 3. Department of Internal Medicine III, Hospital of the University of Munich, Munich, Germany, Munich, Germany. 4. Department of Radiation Oncology, Hospital of the University of Munich, Munich, Germany, Munich, Germany. 5. Department of Molecular Radiation Oncology, German Cancer Research Center, Heidelberg, Germany, Munich, Germany. 6. Department of Clinical Radiology, Hospital of the University of Munich, Munich, Germany.
Abstract
BACKGROUND: Pancreatic cancer is a highly aggressive malignancy and will become the second leading cause of cancer-related death in the USA and also in Germany by 2030. Furthermore, the majority of patients with pancreatic ductal adenocarcinoma (PDAC) will present with distant metastases, limiting surgical management in this population as there is little evidence available to support surgical or ablative treatment options for advanced-stage disease. However, highly selected patients suffering from synchronous and metachronous oligometastatic PDAC may potentially benefit from a surgical resection with an acceptable morbidity. METHODS: This review summarizes and discusses the current literature on the management of oligometastatic disease regarding PDAC, focusing on para-aortic lymph nodes as well as isolated hepatic and pulmonary metastases. RESULTS AND CONCLUSION: In order to further investigate the feasibility and efficacy of such an approach, a prospective multicenter trial, in which survival and quality of life after metastatic resection and systemic chemotherapy is evaluated, has to be initiated. Additionally, local and locoregional ablation techniques or stereotactic body radiation therapy as therapeutic options for isolated metastases in PDAC need further research in order to determine their significance and benefit.
BACKGROUND:Pancreatic cancer is a highly aggressive malignancy and will become the second leading cause of cancer-related death in the USA and also in Germany by 2030. Furthermore, the majority of patients with pancreatic ductal adenocarcinoma (PDAC) will present with distant metastases, limiting surgical management in this population as there is little evidence available to support surgical or ablative treatment options for advanced-stage disease. However, highly selected patients suffering from synchronous and metachronous oligometastatic PDAC may potentially benefit from a surgical resection with an acceptable morbidity. METHODS: This review summarizes and discusses the current literature on the management of oligometastatic disease regarding PDAC, focusing on para-aortic lymph nodes as well as isolated hepatic and pulmonary metastases. RESULTS AND CONCLUSION: In order to further investigate the feasibility and efficacy of such an approach, a prospective multicenter trial, in which survival and quality of life after metastatic resection and systemic chemotherapy is evaluated, has to be initiated. Additionally, local and locoregional ablation techniques or stereotactic body radiation therapy as therapeutic options for isolated metastases in PDAC need further research in order to determine their significance and benefit.
Entities:
Keywords:
Isolated metastasis; Oligometastatic pancreatic ductal adenocarcinoma; Pancreatic cancer
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