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Int J Radiat Oncol Biol Phys. 2018 Apr 1;100(5):1155-1174. doi: 10.1016/j.ijrobp.2017.12.287.

Management of Borderline Resectable Pancreatic Cancer.

Author information

1
Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California.
2
Department of Surgery, Stanford Cancer Institute, Stanford, California.
3
Department of Medical Oncology, Stanford Cancer Institute, Stanford, California.
4
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
5
Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California. Electronic address: dtchang@stanford.edu.

Abstract

With the rapid development of imaging modalities and surgical techniques, the clinical entity representing tumors that are intermediate between resectable and unresectable pancreatic adenocarcinoma has been identified has been termed "borderline resectable" (BR). These tumors are generally amenable for resection but portend an increased risk for positive margins after surgery and commonly necessitate vascular resection and reconstruction. Although there is a lack of consensus regarding the appropriate definition of what constitutes a BR pancreatic tumor, it has been demonstrated that this intermediate category carries a particular prognosis that is in between resectable and unresectable disease. In order to downstage the tumor and increase the probability of clear surgical margins, neoadjuvant therapy is being increasingly utilized and studied. There is a lack of high-level evidence to establish the optimal treatment regimen for BR tumors. When resection with negative margins is achieved after neoadjuvant therapy, the prognosis for BR tumors approaches and even exceeds that for resectable disease. This review presents the current definitions, different treatment approaches, and the clinical outcomes of BR pancreatic cancer.

PMID:
29722658
DOI:
10.1016/j.ijrobp.2017.12.287
[Indexed for MEDLINE]

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