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Multidisciplinary management of locally advanced–borderline resectable adenocarcinoma of the head of the pancreas

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  • NEW TRENDS IN CLINICAL ONCOLOGY
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Abstract

Borderline resectable pancreatic head carcinoma is a challenging disease that requires multidisciplinary approach to obtain maximal benefits from current therapeutical possibilities. We review current knowledge and therapeutic options for the patients from the surgical, medical oncology and radiotherapy views and emphasize the need for a coordinated multidisciplinary approach to obtain optimal results.

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References

  1. Jemal A, Siegel R, Xu J, Ward E (2010) Cancer Statistics 2010. CA Cancer J Clin 60:227–300

    Article  Google Scholar 

  2. Yeo CJ, Abrams RA, Grochow LB et al (1997) Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiotherapy improves survival. A prospective single institution experience. Ann Surg 225:621–633

    Article  PubMed  CAS  Google Scholar 

  3. Callery MP, Chang KJ, Fishman EK et al (2009) Pretreatment assessment of respectable and borderline respectable pancreatic cancer: expert consensus statement. Ann Surg Oncol 16:1727–1733

    Article  PubMed  Google Scholar 

  4. Buchs NC, Chilcott M, Poletti PA, Buhler LH, Morel P (2010) Vascular invasion in pancreatic cancer. Imaging modalities preoperative diagnosis and surgical management. World J Gastroenterol 16(7):818–831

    PubMed  Google Scholar 

  5. Soriano A, Castell A, Ayuso C, Ayuso JR, de Caralt MT, Gines MA et al (2004) Preoperative staging and tumour resectability assessment of pancreatic cancer; prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging and angiography. Am J Gastroenterol 99:492–501

    Article  PubMed  Google Scholar 

  6. Baek SY, Sheafor DH, Keogan MT, DeLong DM, Nelson RC (2001) Two-dimensional multiplanar and three-dimensional volume-rendered vascular CT in pancreatic carcinoma: interobserver agreement and comparison with standard helical techniques. AJR Am J Roentgenol 176:1467–1473

    PubMed  CAS  Google Scholar 

  7. Li H, Zeng MS, Zhou KR, Jin OY, Lou WH (2005) Pancreatic adenocarcinoma: the different CT criteria for peripancreatic major arterial and venous invasion. J Comput Assist Tomogr 29:170–175

    Article  PubMed  Google Scholar 

  8. Lopez Hänninen E, Anithauer H, Hosten N et al (2002) Prospective evaluation of pancreatic tumours: accuracy of MR imaging with MR cholangiopancreatography and MR angiography. Radiology 224:34–41

    Article  PubMed  Google Scholar 

  9. Adamek HE, Albert J, Breer H, Weitz M, Schilling D, Riemann JF (2000) Pancreatic cancer detection with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography: a prospective controlled study. Lancet 356:190–193

    Article  PubMed  CAS  Google Scholar 

  10. Varadarajulu S, Eloubiedi MA (2005) The role of endoscopic ultrasonography in the evaluation of pancreatico-biliary cancer. Gastrointest Endosc Clin N Am 15(3):497–511

    Article  PubMed  Google Scholar 

  11. Yussof IF, Meldenson RM, Edmuds SE et al (2003) Preoperative assessment of pancreatic malignancy using endoscopic ultrasound. Abdom Imaging 28:556–562

    Article  Google Scholar 

  12. Sendler A, Avril N, Helmberger H et al (2000) Preoperative evaluation of pancreatic masses with positron emission tomography using 18F-fluorodeoxyglucose: diagnostic limitations. World J Surg 24:1121–1129

    Article  PubMed  CAS  Google Scholar 

  13. Sato E (2004) Pancreatic cancer imaging: which method? JOP 5:253–257

    Google Scholar 

  14. Chang KJ (2006) EUS-guided fine-needle injection (FNI) and antitumour therapy. Endoscopy 38:s88–s93

    Article  PubMed  Google Scholar 

  15. Chang KJ (2006) State of the art lecture: endoscopic ultrasound and FNA in pancreatico-biliary tumours. Endoscopy 38(suppl):s56–s60

    Article  PubMed  Google Scholar 

  16. Boujaoude J (2007) Role of endoscopic ultrasound in diagnosis and therapy of pancreatic adenocarcinoma. World J Gastroenterol 13:3662–3666

    PubMed  Google Scholar 

  17. Jhala NC, Jhala D, Eltoum I et al (2004) Endoscopic ultrasound-guided fine-needle aspiration biopsy: a powerful tool to obtain samples from small lesions. Cancer 102:239–246

    Article  PubMed  Google Scholar 

  18. Micames C, Jowel PS, White PR et al (2003) Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-guided FNA versus percutaneous FNA. Gastrointest Endosc 58:690–695

    Article  PubMed  Google Scholar 

  19. Vollmer CM, Debrin JA, Middleton WD et al (2002) Utility of staging laparoscopy in subsets of peripancreatic and biliary malignancies. Ann Surg 235:1–7

    Article  PubMed  Google Scholar 

  20. Pisters PW, Lee JE, Vauthey JN et al (2001) Laparoscopy in the staging of pancreatic cancer. Br J Surg 88:325–337

    Article  PubMed  CAS  Google Scholar 

  21. Ahmed SI, Bochkarev V, Oleynikov D et al (2006) Patients with pancreatic adenocarcinoma benefit from staging laparoscopy. J Laparoendosc Adv Surg Tech A 16:458–463

    Article  PubMed  Google Scholar 

  22. Warsaw AL, Gu ZY, Wittemberg J et al (1990) Preoperative staging and assessment of pancreatic cancer. Arch Surg 125:230–233

    Article  Google Scholar 

  23. Andersson R, Vagianos CE, Williamson RCN (2004) Preoperative staging and evaluation of resectability in pancreatic ductal adenocarcinoma. HPB (Oxford) 6:5–12

    Article  CAS  Google Scholar 

  24. Karachristos A, Sacrameas N, Hoffman JC (2005) CA 19-9 levels predict results of staging laparoscopy in pancreatic cancer. J Gastrointest Surg 9:1286–1292

    Article  PubMed  Google Scholar 

  25. White R, Winston C, Gonem N et al (2008) Current utility of staging laparoscopy for pancreatic and peripancreatic neoplasms. J Am Coll Surg 206:445–450

    Article  PubMed  Google Scholar 

  26. Gillen S, Schuster T, Meyer Zum Büschenfelde C, Friess H, Kleeff J (2010) Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med 7(4):e1000267

    Article  PubMed  Google Scholar 

  27. Katz MH, Pisters PW, Evans DB et al (2008) Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg 206(5):833–848

    Article  PubMed  Google Scholar 

  28. Burris HA 3rd, Moore MJ, Andersen J et al (1997) Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15:2403–2413

    PubMed  CAS  Google Scholar 

  29. Moore MJ, Goldstein D, Hamm J et al (2007) Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 25:1960–1966

    Article  PubMed  CAS  Google Scholar 

  30. Conroy T, Desseigne F, Ychou M et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364(19):1817–1825

    Article  PubMed  CAS  Google Scholar 

  31. Ishii H, Furuse J, Boku N et al (2010) Phase II study of gemcitabine chemotherapy alone for locally advanced pancreatic carcinoma: JCOG0506. Jpn J Clin Oncol 40(6):573–579

    Article  PubMed  Google Scholar 

  32. Sahora K, Kuehrer I, Eisenhut A et al (2011) NeoGemOx: gemcitabine and oxaliplatin as neoadjuvant treatment for locally advanced, nonmetastasized pancreatic cancer. Surgery 149(3):311–320

    Article  PubMed  Google Scholar 

  33. Sahora K, Kuehrer I, Schindl M, Koelblinger C, Goetzinger P, Gnant M (2011) NeoGemTax: gemcitabine and docetaxel as neoadjuvant treatment for locally advanced nonmetastasized pancreatic cancer. World J Surg 35(7):1580–1589

    Article  PubMed  Google Scholar 

  34. Louvet C, Labianca R, Hammel P et al (2005) Gemcitabine in combination with oxaliplatin compared with gemcitabine alone in locally advanced or metastatic pancreatic cancer: results of a GERCOR and GISCAD phase III trial. J Clin Oncol 23(15):3509–3516

    Article  PubMed  CAS  Google Scholar 

  35. Rocha Lima CM, Green MR, Rotche R et al (2004) Irinotecan plus gemcitabine results in no survival advantage compared with gemcitabine monotherapy in patients with locally advanced or metastatic pancreatic cancer despite increased tumour response rate. J Clin Oncol 22(18):3776–3783

    Article  PubMed  CAS  Google Scholar 

  36. Von Hoff DD, Ramanathan RK, Borad MJ et al (2011) Gemcitabine plus nab-paclitaxel is an active regimen in patients with advanced pancreatic cancer: a phase I/II trial. J Clin Oncol 29(34):4548–4554

    Article  Google Scholar 

  37. Kircher SM, Krantz SB, Nimeiri HS et al (2011) Therapy of locally advanced pancreatic adenocarcinoma unresectable and borderline patients. Exp Rev Anticancer Ther 11(10):1555–1565

    Article  Google Scholar 

  38. Brunner TB, Scott-Brown M (2010) The role of radiotherapy in multimodal treatment of pancreatic carcinoma. Radiat Oncol 5:64–76

    Article  PubMed  Google Scholar 

  39. Brunner TB, Grabenbauer G, Meyer T et al (2007) Primary resection versus neoadjuvant chemoradiation followed by resection for locally resectable or potentially resectable pancreatic carcinoma without distant metastasis. A multicentre prospectively randomised phase II-study of the Interdisciplinary Working Group Gastrointestinal Tumours (AIO, ARO, and CAO). BMC Cancer 7:41

    Article  PubMed  Google Scholar 

  40. Stessin AM, Meyer JE, Sherr DL (2008) Neoadjuvant radiation is associated with improved survival in patients with resectable pancreatic cancer: an analysis of data from the surveillance, epidemiology, and end results (SEER) registry. Int J Radiat Oncol Biol Phys 72(4):1128–1133

    Article  PubMed  Google Scholar 

  41. Hoffman JP, Lipsitz S, Pisansky T, Weese JL, Solin L, Benson AB III (1998) Phase II trial of preoperative radiation therapy and chemotherapy for patients with localized, resectable adenocarcinoma of the pancreas: an Eastern Cooperative Oncology Group Study. J Clin Oncol 16(1):317–323

    PubMed  CAS  Google Scholar 

  42. Hoffman JP, Pendurthi TK, Ross E, Yeung RS (1998) Preoperative radiation therapy and chemotherapy for adenocarcinoma of the pancreas. Hepatogastroenterology 45(21):634–637

    PubMed  CAS  Google Scholar 

  43. Sasson AR, Wetherington RW, Hoffman JP et al (2003) Neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreas: analysis of histopathology and outcome. Int J Gastrointest Cancer 34(2–3):121–128

    Article  PubMed  Google Scholar 

  44. Snady H, Bruckner H, Cooperman A, Paradiso J, Kiefer L (2000) Survival advantage of combined chemoradiotherapy compared with resection as the initial treatment of patients with regional pancreatic carcinoma. An outcomes trial. Cancer 89(2):314–327

    Article  PubMed  CAS  Google Scholar 

  45. Breslin TM, Hess KR, Harbison DB et al (2001) Neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreas: treatment variables and survival duration. Ann Surg Oncol 8(2):123–132

    Article  PubMed  CAS  Google Scholar 

  46. White RR, Xie HB, Gottfried MR et al (2005) Significance of histological response to preoperative chemoradiotherapy for pancreatic cancer. Ann Surg Oncol 12(3):214–221

    Article  PubMed  Google Scholar 

  47. Evans DB, Varadhachary GR, Crane CH et al (2008) Preoperative gemcitabine based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol 26(21):3496–3502

    Article  PubMed  CAS  Google Scholar 

  48. Golcher H, Brunner T, Grabenbauer G et al (2008) Preoperative chemoradiation in adenocarcinoma of the pancreas. A single centre experience advocating a new treatment strategy. Eur J Surg Oncol 34(7):756–764

    Article  PubMed  CAS  Google Scholar 

  49. Roy R, Maraveyas A (2010) Chemoradiation in pancreatic adenocarcinoma: a literature review. Oncologist 15(3):259–269

    Article  PubMed  CAS  Google Scholar 

  50. Huguet F, André T, Hammel P et al (2007) Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol 25(3):326–331

    Article  PubMed  CAS  Google Scholar 

  51. Brown KM, Siripurapu V, Davidson M et al (2008) Chemoradiation followed by chemotherapy before resection for borderline pancreatic adenocarcinoma. Am J Surg 195(3):318–321

    Article  PubMed  CAS  Google Scholar 

  52. Krishnan S, Rana V, Janjan NA et al (2007) Induction chemotherapy selects patients with locally advanced, unresectable pancreatic cancer for optimal benefit from consolidative chemoradiation therapy. Cancer 110(1):47–55

    Article  PubMed  Google Scholar 

  53. Landry J, Catalano PJ, Staley C et al (2010) Randomized phase II study of gemcitabine plus radiotherapy versus gemcitabine, 5-fluorouracil, and cisplatin followed by radiotherapy and 5-fluorouracil for patients with locally advanced, potentially resectable pancreatic adenocarcinoma. J Surg Oncol 101(7):587–592

    Article  PubMed  CAS  Google Scholar 

  54. Pedrazzoli S, Di Carlo V, Dionigi R et al (1998) Standard vs extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter prospective randomized study. Lymphadenectomy study group. Ann Surg 228:508–517

    Article  PubMed  CAS  Google Scholar 

  55. Nimura Y, Nagino M, Kato H et al (2004) Regional vs extended lymphadenectomy for pancreatic cancer. A multicenter randomized controlled trial. HPB 6:2

    Google Scholar 

  56. Yeo CJ, Cameron JL, Sohn TA et al (1999) Pancreatoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short term outcome. Ann Surg 229:613–622

    Article  PubMed  CAS  Google Scholar 

  57. Yeo CJ, Cameron JL, Lillemoe KD et al (2002) Pancreatoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma part 2: randomized controlled trial evaluating survival, morbidity and mortality. Ann Surg 236:355–366

    Article  PubMed  Google Scholar 

  58. Nguyen TC, Sohn TA, Cameron JL et al (2003) Standard vs radical pancreatoduodenectomy for periampullary adenocarcinoma a prospective randomized trial evaluating quality of life in pancreatoduodenectomy survivors. J Gastrointest Surg 7:1–9

    Article  PubMed  Google Scholar 

  59. Riall TS, Cameron JL, Lillemoe KD et al (2005) Pancreatoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma part 3: update on 5-year survival. J Gastrointest Surg 9:1191–1204

    Article  PubMed  Google Scholar 

  60. Farnell MB, Pearson RK, Sarr MG et al (2005) A prospective randomized trial comparing pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in respectable pancreatic head carcinoma. Surgery 138:618–628

    Article  PubMed  Google Scholar 

  61. Fortner JG (1973) Regional resection of cancer of the pancreas a new surgical approach. Surgery 73:307–320

    PubMed  CAS  Google Scholar 

  62. Tseng JF, Raut CP, Lee JE et al (2004) Pancreatoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 8:935–949

    Article  PubMed  Google Scholar 

  63. Raut CP, Tseng JF, Sun CC et al (2007) Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg 246:52–56

    Article  PubMed  Google Scholar 

  64. Al-Haddad M, Martin JK, Nguyen J et al (2007) Vascular resection and reconstruction for pancreatic malignancy: a single center survival study. J Gastrointest Surg 11:1168–1174

    Article  PubMed  Google Scholar 

  65. Siriwardana HP, Siriwardena AK (2006) Systematic review of outcome of synchronous portal-superior mesenteric vein resection during pancreatectomy for cancer. Br J Surg 93:662–673

    Article  PubMed  CAS  Google Scholar 

  66. Horio T, Sugiura Y, Aiko S et al (2009) Pancreatectomy for pancreatic cancer with reference to combined resection of the vessels, twenty nine year experience by a single surgeon. Keio J Med 58:103–109

    Article  PubMed  Google Scholar 

  67. Stitzenberg KB, Watson JC, Roberts A et al (2008) Survival after pancreatectomy with major arterial resection and reconstruction. Ann Surg Oncol 15:1399–1406

    Article  PubMed  Google Scholar 

  68. Nakao A, Takeda S, Inoue S et al (2006) Indications and techniques of extended resection for pancreatic cancer. World J Surg 30:976–982

    Article  PubMed  Google Scholar 

  69. Baulieux J, Adham M, Oussoultzoglou E et al (1998) La pancreatectomie pour cancer avec résection des vaisseaux rétropancreatiques est-elle justifiée? Ann Chir 123:438–444

    CAS  Google Scholar 

  70. Martin RC, Scoggins CR, Egnatashvili V et al (2009) Arterial and venous resection for pancreatic adenocarcinoma. Arch Surg 144:154–159

    Article  PubMed  Google Scholar 

  71. Miller RC, Valentini V, Moss A et al (2010) Pancreas cancer. In: Gunderson LL, Willett CG, Calvo FA, Harrison LB (eds) Intraoperative irradiation, 2nd edn. Springer/Humana Press, New York, pp 249–271

    Google Scholar 

  72. Sindelar WF, Kinsella TJ (1999) Studies of intraoperative radiotherapy in carcinoma of the pancreas. Ann Oncol 4:226–230

    Article  Google Scholar 

  73. Ruano-Ravina A, Almazán R, Guedea F (2008) Intraoperative radiotherapy in pancreatic cancer: a systematic review. Radiother Oncol 87:318–325

    Article  PubMed  Google Scholar 

  74. Valentini V, Calvo FA, Reni M et al (2009) Intraoperative radiotherapy in pancreatic cancer: joint analysis of the ISIORT-Europe experience. Radiother Oncol 91:54–59

    Article  PubMed  Google Scholar 

  75. Calvo FA, Valentini V (2008) Radiotherapy for pancreatic cancer: systematic nihilism of intraoperative realismo. Radiother Oncol 87:314–317

    Article  PubMed  Google Scholar 

  76. Greer SE, Pipas JM, Sutton JE et al (2008) Effect of neoadjuvant therapy on local recurrence after resection of pancreatic adenocarcinoma. J Am Coll Surg 206(3):451–457

    Article  PubMed  Google Scholar 

  77. Kalser MH, Ellenberg SS (1985) Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 120(8):899–903

    Article  PubMed  CAS  Google Scholar 

  78. (1987) Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Gastrointestinal Tumour Study Group. Cancer 59(12):2006–2010

  79. Klinkenbijl JH, Jeekel J, Sahmoud T et al (1999) Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC Gastrointestinal Tract Cancer Cooperative Group. Ann Surg 230(6):776–782

    Article  PubMed  CAS  Google Scholar 

  80. Neoptolemos JP, Dunn JA, Stocken DD et al (2001) Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomized controlled trial. Lancet 358(9293):1576–1585

    Article  PubMed  CAS  Google Scholar 

  81. Neoptolemos JP, Stocken DD, Friess H et al (2004) A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 350(12):1200–1210

    Article  PubMed  CAS  Google Scholar 

  82. Stocken DD, Buchler MW, Dervenis C et al (2005) Meta-analysis of randomized adjuvant therapy trials for pancreatic cancer. Br J Cancer 92(8):1372–1381

    Article  PubMed  CAS  Google Scholar 

  83. Hsu CC, Herman JM, Corsini MM et al (2010) Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study. Ann Surg Oncol 17(4):981–990

    Article  PubMed  Google Scholar 

  84. Demols A, Peeters M, Polus M et al (2005) Adjuvant gemcitabine and concurrent continuous radiation (45 Gy) for resected pancreatic head carcinoma: a multicenter Belgian Phase II study. Int J Radiat Oncol Biol Phys 62(5):1351–1356

    Article  PubMed  CAS  Google Scholar 

  85. Wilkowski R, Thoma M, Duhmke E, Rau HG, Heinemann V (2004) Concurrent chemoradiotherapy with gemcitabine and cisplatin after incomplete (R1) resection of locally advanced pancreatic carcinoma. Int J Radiat Oncol Biol Phys 58(3):768–772

    Article  PubMed  CAS  Google Scholar 

  86. Blackstock AW, Mornex F, Partensky C et al (2006) Adjuvant gemcitabine and concurrent radiation for patients with resected pancreatic cancer: a phase II study. Br J Cancer 95(3):260–265

    Article  PubMed  CAS  Google Scholar 

  87. Regine WF, Winter KA, Abrams R et al (2011) Fluorouracil-based chemoradiation with either gemcitabine or fluorouracil chemotherapy after resection of pancreatic adenocarcinoma: 5-year analysis of the U.S. Intergroup/RTOG 9704 phase III trial. Ann Surg Oncol 18(5):1319–1326

    Article  PubMed  Google Scholar 

  88. Bakkevold KE, Arnesjo B, Dahl O, Kambestad B (1993) Adjuvant combination chemotherapy (AMF) following radical resection of carcinoma of the pancreas and papilla of Vater—results of a controlled, prospective, randomized multicentre study. Eur J Cancer 29A(5):698–703

    Article  PubMed  CAS  Google Scholar 

  89. Takada T, Amano H, Yasuda H et al (2002) Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A Phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer 95(8):1685–1695

    Article  PubMed  Google Scholar 

  90. Oettle H, Post S, Neuhaus P et al (2007) Adjuvant chemotherapy with gemcitabine versus observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 297(3):267–277

    Article  PubMed  CAS  Google Scholar 

  91. Neoptolemos JP, Stocken DD, Bassi C et al (2010) Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA 304(10):1073–1081

    Article  PubMed  CAS  Google Scholar 

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Correspondence to A. Sanjuanbenito Dehesa.

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Calvo, F., Guillen Ponce, C., Muñoz Beltran, M. et al. Multidisciplinary management of locally advanced–borderline resectable adenocarcinoma of the head of the pancreas. Clin Transl Oncol 15, 173–181 (2013). https://doi.org/10.1007/s12094-012-0962-4

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