Neoadjuvant therapy of pancreatic cancer: The emerging paradigm?

Kian Huat Lim, Eugene Chung, Adeel Khan, Dengfeng Cao, David Linehan, Edgar Ben-Josef, Andrea Wang-Gillam

Research output: Contribution to journalReview articlepeer-review

63 Scopus citations

Abstract

Pancreatic cancer remains one of the deadliest cancers due to difficulty in early diagnosis and its high resistance to chemotherapy and radiation. It is now clear that even patients with potentially resectable disease require multimodality treatment including chemotherapy and/or radiation to improve resectability and reduce recurrence. Tremendous efforts are currently being invested in refining preoperative staging to identify optimal surgical candidates, and also in developing various neoadjuvant or adjuvant regimens to improve surgical outcome. Although at present no studies have been done to directly compare the benefit of neoadjuvant versus adjuvant approaches, accumulating evidence suggests that the neoadjuvant approach is probably beneficial for a subset of the patient population, particularly those with borderline resectable disease in which complete surgical resection is almost certainly unachievable. In this article, we review the literature and rationales of neoadjuvant chemotherapy and chemoradiation, as well as their potential limitations and caveats. We also review the pathological findings following neoadjuvant therapies, and potential surgical complications that may be associated with neoadjuvant therapies.

Original languageEnglish
Pages (from-to)192-200
Number of pages9
JournalOncologist
Volume17
Issue number2
DOIs
StatePublished - 2012

Keywords

  • Borderline resectable
  • Borderline resectable chemotherapy
  • Chemoradiation
  • Neoadjuvant
  • Pancreatic cancer

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