Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10740
Revised: February 6, 2014
Accepted: March 19, 2014
Published online: August 21, 2014
Pancreatic cancer is the fourth leading cause of cancer death in the United States. While surgical resection remains the only curative option, more than 80% of patients present with unresectable disease. Unfortunately, even among those who undergo resection, the reported median survival is 15-23 mo, with a 5-year survival of approximately 20%. Disappointingly, over the past several decades, despite improvements in diagnostic imaging, surgical technique and chemotherapeutic options, only modest improvements in survival have been realized. Nevertheless, it remains clear that surgical resection is a prerequisite for achieving long-term survival and cure. There is now emerging consensus that a subgroup of patients, previously considered poor candidates for resection because of the relationship of their primary tumor to surrounding vasculature, may benefit from resection, particularly when preceded by neoadjuvant therapy. This stage of disease, termed borderline resectable pancreatic cancer, has become of increasing interest and is now the focus of a multi-institutional clinical trial. Here we outline the history, progress, current treatment recommendations, and future directions for research in borderline resectable pancreatic cancer.
Core tip: Borderline resectable pancreatic cancer has become recognized as a clinical entity worthy of study based on a number of clinical observations that recognize a continuum between resectable and locally advanced unresectable disease. There are few prospective trials and therefore no data to support specific treatment regimens in borderline resectable pancreatic ductal adenocarcinoma (PDAC). Difficulties in achieving a consensus, objective definition, small numbers of patients and variability in therapeutic algorithms have delayed progress in establishing strong evidence-based practices for diagnosis and treatment. The Alliance trial represents a first step in establishing reproducible standards by which future trials in borderline resectable PDAC can abide.