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Neoadjuvant Treatment for Resectable and Locally Advanced Pancreatic Cancer

  • Rebecca P. Petersen
  • Johanna C. Bendell
  • Brian G. Czito
  • Douglas S. Tyler
Part of the M. D. Anderson Solid Tumor Oncology Series book series (MDA)

Pancreatic carcinoma is the fourth leading cause of cancer death in the United States, resulting in over 30,000 deaths per year. The overall prognosis is poor, with a 5-year survival rate of 4% for all stages (1). Although it is debatable if this disease can be cured through surgical resection, only a minority of patients (15–20%) present with potentially resectable disease that warrants an attempt at surgery. Even with advances in operative techniques and perioperative care, prognosis remains suboptimal for patients undergoing complete resection, as the 5-year survival is <20% (2). Efforts to improve on outcomes with radical surgery have focused on combined strategies of adjuvant and neoadjuvant chemotherapy alone or in conjunction with radiation therapy.

In an attempt to improve upon the efficacy of adjuvant chemoradiation therapy, interest in neoadjuvant treatment approaches has increased. Approximately one third of patients who undergo resection do not receive planned postoperative therapy due to complications of surgery or delayed recovery ( 3, 4 ). In contrast, all patients who are resected following neoadjuvant therapy have received the potential benefit of multimodality therapy and there appears to be a significantly lower rate of major complications post-pancreaticoduodenectomy, such as pancreatic leaks (5 ). Other theoretical advantages include improved delivery of chemotherapy and radiosensitizing oxygen to tissues whose blood supply has not been disrupted by surgery, as well as the avoidance of irradiation to fixed loops of bowel postoperatively.

Keywords

Pancreatic Cancer Clin Oncol Advanced Pancreatic Cancer Chemoradiation Therapy Resectable Pancreatic Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Rebecca P. Petersen
    • 1
  • Johanna C. Bendell
    • 2
  • Brian G. Czito
    • 3
  • Douglas S. Tyler
    • 1
  1. 1.Department of SurgeryDuke University Medical CenterDurhamUSA
  2. 2.Division of Medical Oncology, Department of MedicineDuke University Medical CenterDurhamUSA
  3. 3.Department of Radiation OncologyDuke University Medical CenterDurhamUSA

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