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Borderline Resectable Pancreatic Cancer

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Pancreatic Cancer

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Abstract

Rigorous criteria are essential to define resectability of PDAC, which allows for accurate pretreatment staging and planning stage-specific therapy. Tumors of borderline resectability have emerged as a distinct subset, and these patients are at a high risk for margin positive resection. The intergroup criteria for BRPC includes: (1) an interface between the tumor and SMV–PV ≥180° of the vein circumference; (2) short-segment occlusion of the SMV–PV with normal vein above and below the obstruction amenable to resection and reconstruction; (3) short-segment interface of any degree between tumor and HA with normal artery proximal and distal to the interface amenable to arterial resection and reconstruction; and (4) interface between the tumor and SMA and/or CA measuring <180° of the circumference of the artery. Two multicytotoxic regimens approved for metastatic disease, 5-flurouracil with oxaliplatin and irinotecan (FOLFIRINOX) and gemcitabine with nab-paclitaxel (Gem-nabP), are incorporated in the preoperative management of BRPC in many centers although high-level evidence data on these regimens in the neoadjuvant setting are not yet available. Those with radiographic stability or regression and an improvement in serum tumor markers (CA19-9) may proceed to pancreatectomy and may require vascular resection and reconstruction. Prospective clinical trials with well-defined eligibility will help determine the treatment strategies. Additionally, prognostic and predictive biomarkers are urgently needed in therapy planning.

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Authors and Affiliations

  1. Department of Gastrointestinal Medical Oncology, University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd. Unit 426, Houston, TX, USA

    Gauri R. Varadhachary

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  1. Gauri R. Varadhachary
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Correspondence to Gauri R. Varadhachary .

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Editors and Affiliations

  1. DMCCMC, University of Liverpool DMCCMC, Liverpool, United Kingdom

    John P. Neoptolemos

  2. Rochester, Minnesota, USA

    Raul Urrutia

  3. Dept. Gastrointestinal Medical Onco, Duke University Medical Center Dept. Gastrointestinal Medical Onco, Durham, North Carolina, USA

    James Abbruzzese

  4. Heidelberg, Germany

    Markus W. Büchler

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Varadhachary, G.R. (2017). Borderline Resectable Pancreatic Cancer. In: Neoptolemos, J., Urrutia, R., Abbruzzese, J., Büchler, M. (eds) Pancreatic Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6631-8_46-2

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