New challenges in perioperative management of pancreatic cancer

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related death in the industrialized world. Despite progress in the understanding of the molecular and genetic basis of this disease, the 5-year survival rate has remained low and usually does not exceed 5%. Only 20%-25% of patients present with potentially resectable disease and surgery represents the only chance for a cure. After decades of gemcitabine hegemony and limited therapeutic options, more active chemotherapies are emerging in advanced PDAC, like 5-Fluorouracil, folinic acid, irinotecan and oxaliplatin and nab-paclitaxel plus gemcitabine, that have profoundly impacted therapeutic possibilities. PDAC is considered a systemic disease because of the high rate of relapse after curative surgery in patients with resectable disease at diagnosis. Neoadjuvant strategies in resectable, borderline resectable, or locally advanced pancreatic cancer may improve outcomes. Incorporation of tissue biomarker testing and imaging techniques into preoperative strategies should allow clinicians to identify patients who may ultimately achieve curative benefit from surgery. This review summarizes current knowledge of adjuvant and neoadjuvant treatment for PDAC and discusses the rationale for moving from adjuvant to preoperative and perioperative therapeutic strategies in the current era of more active chemotherapies and personalized medicine. We also discuss the integration of good specimen collection, tissue biomarkers, and imaging tools into newly designed preoperative and perioperative strategies.

Treatment of locally advanced pancreatic cancer by percutaneous and intraoperative irreversible electroporation: general hospital cancer center experience

“…only 33% of them received post ire chemotherapy and none of them received a surgical resection of the tumor with margin accentuation by ire. The median survival in our patients was comparable with the matched cohort and also with the standard 6 -11 months reported in phase iii trials with chemotherapy alone or in combination with radiotherapy [2,3]. The fact that survival and the presence of complications were independent of the time of ire confirms that the experience of the specialist was adequate from the beginning.…”

“…Pancreatic cancer is characterized by a delayed diagnosis resulting in advanced stage, ineffective treatment, and extremely poor survival that remains around 6% in 5 years [1][2][3][4]. curative resection is possible in less than one fifth of patients [5,6].…”

The Clinical Significance of miR-34a in Pancreatic Ductal Carcinoma and Associated Molecular and Cellular Mechanisms

“…A report from the National Cancer Data Base estimated that there were 39,590 pancreatic cancer deaths in the USA in 2014 [2]. Despite the progress made in diagnostic and therapeutic technology, the 5-year survival rate is only 23% in patients with local disease [3] and <1% in patients with unresectable tumors [4]. The low survival rate might be associated with the aggressive characteristics of PDAC and the lack of biomarkers that can facilitate an early diagnosis and target therapy of pancreatic cancer.…”

Advancement in treatment and diagnosis of pancreatic cancer with radiopharmaceuticals

“…Surgery is the only curative treatment but less than 20% of cases are suitable to Xu YP et al . Development of radiopharmaceuticals in PC theragnosis be respectable during diagnosis for the late onset of the symptoms [4][5][6] . Therefore, suitable diagnosis and staging is essential for management of the disease.…”