Treatment of Recurrent Pancreatic Cancer After Surgery
The majority of patients with pancreatic cancer eventually develop and die from recurrence even after successful surgical resection and adjuvant therapy. Pancreatic cancer recurrence and its treatment are, therefore, very relevant clinical concerns. For several reasons there is a striking lack of knowledge and evidence with respect to the incidence and pattern, the detection, and the management of pancreatic cancer recurrence. This chapter summarizes available data on the incidence, timing, and pattern of recurrence, discusses the need for and the potential of structured surveillance programs, and provides an overview of treatment options for pancreatic cancer recurrence. While most patients will eventually die from systemic recurrences, a relevant subgroup of 20–30% of patients at first present with isolated local recurrence. For systemic recurrences chemotherapy is the only treatment option. However, data from observational cohort studies suggest that treatment strategies that include local approaches may be associated with prolonged survival patients with isolated local recurrences. In order to improve the treatment of both local and systemic recurrence of pancreatic cancer and to enable clinical trials, it will be important to establish surveillance programs after resection and to address treatment options for recurrence in future guidelines.
KeywordsPancreatic cancer Resection Surveillance Recurrence Isolated local recurrence Systemic recurrence Re-resection Outcome Survival
- CA 19-9
Carbohydrate antigen 19-9
Pancreatic ductal adenocarcinoma
Positron emission tomography
Randomized controlled trial
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