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World J Gastroenterol. Jul 28, 2014; 20(28): 9374-9383
Published online Jul 28, 2014. doi: 10.3748/wjg.v20.i28.9374
Neoadjuvant strategies for pancreatic cancer
Francesco Polistina, Giuseppe Di Natale, Giorgio Bonciarelli, Giovanni Ambrosino, Mauro Frego
Francesco Polistina, Giuseppe Di Natale, Mauro Frego, Department of General Surgery, Monselice Hospital, 35043 Monselice, Italy
Giuseppe Di Natale, Rome University “La Sapienza” School of Surgery, Piazzale Aldo Moro, 500185 Roma, Italy
Giorgio Bonciarelli, Department of Clinical Oncology, Monselice Hospital, 135043 Monselice, Italy
Giovanni Ambrosino, Department of Surgery, Malzoni Hospital, 483100 Avellino, Italy
Author contributions: Polistina F, Bonciarelli G, Frego M and Ambrosino G selected, discussed and criticized the papers for the issue; Di Natale G retrieved the articles and took part to the discussion and drawing of the manuscript; Polistina F draw the manuscript and took part to the revision process together with Frego M, Bonciarelli G and Ambrosino G.
Correspondence to: Francesco Polistina, MD, Department of General Surgery, Monselice Hospital, Ospedale di Monselice, Via G. Marconi 19, 35043 Monselice, Italy. francescopolistina@hotmail.it
Telephone: +39-429-788272 Fax: +39-429-788080
Received: October 29, 2013
Revised: January 3, 2014
Accepted: February 17, 2014
Published online: July 28, 2014
Processing time: 270 Days and 7.6 Hours
Abstract

Pancreatic cancer (PC) is the fourth cause of cancer death in Western countries, the only chance for long term survival is an R0 surgical resection that is feasible in about 10%-20% of all cases. Five years cumulative survival is less than 5% and rises to 25% for radically resected patients. About 40% has locally advanced in PC either borderline resectable (BRPC) or unresectable locally advanced (LAPC). Since LAPC and BRPC have been recognized as a particular form of PC neoadjuvant therapy (NT) has increasingly became a valid treatment option. The aim of NT is to reach local control of disease but, also, it is recognized to convert about 40% of LAPC patients to R0 resectability, thus providing a significant improvement of prognosis for responding patients. Once R0 resection is achieved, survival is comparable to that of early stage PCs treated by upfront surgery. Thus it is crucial to look for a proper patient selection. Neoadjuvant strategies are multiples and include neoadjuvant chemotherapy (nCT), and the association of nCT with radiotherapy (nCRT) given as either a combination of a radio sensitizing drug as gemcitabine or capecitabine or and concomitant irradiation or as upfront nCT followed by nRT associated to a radio sensitizing drug. This latter seem to be most promising as it may select patients who do not go on disease progression during initial treatment and seem to have a better prognosis. The clinical relevance of nCRT may be enhanced by the application of higher active protocols as FOLFIRINOX.

Keywords: Pancreatic cancer; Neoadjuvant; Chemotherap; Radiotherapy; Chemoradiation

Core tip: The present paper is a review on the upcoming issue of neoadjuvant strategies for pancreatic cancer patients. Protocols, timing and results of the largest series from different strategies are here presented and discussed. To authors knowledge this is the first published paper that considers even latest papers on neoadjuvant treatment for even potentially resectable pancreatic cancer.