Locally Advanced Pancreatic Cancer: Work-Up, Staging, and Local Intervention Strategies

Locally advanced pancreatic cancer (LAPC) has several definitions but essentially is a nonmetastasized pancreatic cancer, in which upfront resection is considered not beneficial due to extensive vascular involvement and consequent high chance of a nonradical resection. The introduction of FOLFIRINOX...

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Bibliographic Details
Published in:Cancers 2019-07, Vol.11 (7), p.976
Main Authors: van Veldhuisen, Eran, van den Oord, Claudia, Brada, Lilly J, Walma, Marieke S, Vogel, Jantien A, Wilmink, Johanna W, Del Chiaro, Marco, van Lienden, Krijn P, Meijerink, Martijn R, van Tienhoven, Geertjan, Hackert, Thilo, Wolfgang, Christopher L, van Santvoort, Hjalmar, Groot Koerkamp, Bas, Busch, Olivier R, Molenaar, I Quintus, van Eijck, Casper H, Besselink, Marc G
Format: Article
Language:English
Subjects:
Ablation
Antigens
Biomarkers
Cancer therapies
Chemotherapy
Electroporation
Endoscopy
Fibrosis
Gemcitabine
Laparoscopy
Liver
Metastasis
Ostomy
Paclitaxel
Pancreatic cancer
Patients
Radiation therapy
Review
Surgery
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Summary:Locally advanced pancreatic cancer (LAPC) has several definitions but essentially is a nonmetastasized pancreatic cancer, in which upfront resection is considered not beneficial due to extensive vascular involvement and consequent high chance of a nonradical resection. The introduction of FOLFIRINOX chemotherapy and gemcitabine-nab-paclitaxel (gem-nab) has had major implications for the management and outcome of patients with LAPC. After 4-6 months induction chemotherapy, the majority of patients have stable disease or even tumor-regression. Of these, 12 to 35% are successfully downstaged to resectable disease. Several studies have reported a 30-35 months overall survival after resection; although it currently remains unclear if this is a result of the resection or the good response to chemotherapy. Following chemotherapy, selection of patients for resection is difficult, as contrast-enhanced computed-tomography (CT) scan is unreliable in differentiating between viable tumor and fibrosis. In case a resection is not considered possible but stable disease is observed, local ablative techniques are being studied, such as irreversible electroporation, radiofrequency ablation, and stereotactic body radiation therapy. Pragmatic, multicenter, randomized studies will ultimately have to confirm the exact role of both surgical exploration and ablation in these patients. Since evidence-based guidelines for the management of LAPC are lacking, this review proposes a standardized approach for the treatment of LAPC based on the best available evidence.
ISSN:2072-6694
2072-6694
DOI:10.3390/cancers11070976