Management of locally advanced and recurrent pancreas cancer

Pancreatic cancer remains a devastating disease. In 2007 the estimated incidence of the disease in the USA is 37,170 with an expected 33,370 deaths [1]. At the time of diagnosis, 80% of patients have locally advanced or advanced disease for which no curative therapy exist, and 80% of patients treated with curative intent will recur in the first 2 years after surgical resection and will succumb to their disease [2]. Locally advanced pancreatic cancer is usually defined as patients with American Joint Committee on Cancer (6th edition) T4 lesions, where the primary tumor involves branches of the celiac axis or the superior mesenteric artery, indicating an unresectable primary tumor and representing stage III disease. These patients often require operative or nonoperative palliation of disease-related processes such as obstructive jaundice, gastroduodenal obstruction, or abdominal pain. Focused anticancer treatment for such locally advanced pancreatic adenocarcinoma can involve chemoradiation approaches, chemotherapy alone, or locally directed therapy.