Neoadjuvant Chemotherapy and Radiochemotherapy: Is There a Survival Advantage for Pancreatic Cancer Patients?

Susan Tsai, Ben George, Kathleen K. Christians, Douglas B. Evans

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Pancreatic cancer is the fourth leading cause of adult cancer mortality in the United States with an expected 44,030 incident cases and 37,660 deaths in 2011; it remains an unsolved health problem and, arguably, the solid tumor of greatest biologic complexity. Although operative resection offers the only opportunity for cure, "curative" resection is a modest treatment for this disease. Currently, complete resection (R0) is necessary but clearly not sufficient to achieve long-term survival in the majority of patients. Even among patients with early stage pancreatic cancer (stages I and II) in whom cross-sectional imaging demonstrates a resectable primary tumor without distant metastases, recurrent disease occurs in the majority of patients after potentially "curative" surgery. The clinical observation that almost all patients with biopsy-proven pancreatic adenocarcinoma have radiographically occult metastatic disease in distant sites remains the most compelling argument against a surgery-first strategy for this disease. Advances in operative and perioperative care have decreased the morbidity and mortality associated with pancreatic surgery, which has in turn increased the frequency and complexity of operations performed. Nevertheless, notwithstanding the extent of resection and lymphadenectomy, even when performed safely, the median survival for patients with pancreatic cancer treated with a surgery-first strategy has not changed since the mid-1980s. The inadequacy of resection alone and the inability to reliably deliver postoperative adjuvant therapy after such large operations has led to a more widespread interest in the application of nonsurgical systemic therapies and chemoradiation before pancreatectomy in an effort to improve survival-a basic principle of oncology that has been applied to all other high-risk solid tumors. Herein, we review the potential advantages and ongoing challenges of preoperative or neoadjuvant treatment sequencing in patients with resectable and borderline resectable pancreatic cancer.

Original languageEnglish (US)
Title of host publicationPancreatic Cancer, Cystic Neoplasms and Endocrine Tumors: Diagnosis and Management
PublisherWiley Blackwell
Pages103-119
Number of pages17
ISBN (Electronic)9781118307816
ISBN (Print)9780470673188
DOIs
Publication statusPublished - Apr 7 2015
Externally publishedYes

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Keywords

  • Adjuvant chemotherapy
  • Borderline resectable
  • Neoadjuvant chemoradiotherapy
  • Pancreatic cancer

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Tsai, S., George, B., Christians, K. K., & Evans, D. B. (2015). Neoadjuvant Chemotherapy and Radiochemotherapy: Is There a Survival Advantage for Pancreatic Cancer Patients? In Pancreatic Cancer, Cystic Neoplasms and Endocrine Tumors: Diagnosis and Management (pp. 103-119). Wiley Blackwell. https://doi.org/10.1002/9781118307816.ch13