Borderline resectable pancreatic cancer: Definitions and management

Table 1 Comparison of radiographic differences in common definitions for borderline resectable pancreatic cancer

Effected vessel	AHPBA/SSAT/SSO/NCCN[29]	MD Anderson[28]	Alliance[26]
SMV/PV	Abutment, impingement, encasement of the SMV/PV or short segment venous occlusion	Occlusion	Tumor-vessel interface ≥ 180° of vessel wall circumference, and/or reconstructable occlusion
SMA	Abutment	Abutment	Tumor-vessel interface < 180° of vessel wall circumference
HA	Abutment or short segment encasement	Abutment or short segment encasement	Reconstructable short segment interface of any degree between tumor and vessel wall
CA	Uninvolved	Abutment	Tumor-vessel interface < 180° of vessel wall circumference

AHPBA/SSAT/SSO/NCCN: Americas Hepatopancreaticobiliary Association/Society for Surgery of the Alimentary Tract/Society of Surgical Oncology/National Comprehensive Cancer Network; SMV/PV: Superior mesenteric vein/portal vein; SMA: Superior mesenteric artery; HA: Hepatic artery; CA: Celiac artery.

Table 2 Largest studies in borderline resectable pancreatic cancer

Author	Year	Study type	Study size	Number with borderline resectable (definition)	Neoadjuvant	Resected	Negative margins	Median OS (mo)
Chuong et al[86]	2013	Single institution retrospective	73	57 (NCCN)	Majority gemcitabine based induction chemotherapy, SBRT	56%	96%	16.4
Katz et al[87]	2012	Single institution retrospective	129	115 (AHPBA/SSAT/SSO/NCCN)	Gemcitabine based chemotherapy and chemoradiation or chemoradiation alone	84% or 78%	95%1	331
				or
				72 (MDA)
Barugola et al[91]	2012	Single institution retrospective	362	27 (other)	Gemcitabine based chemotherapy and chemoradiation or chemotherapy alone	NR	NR	NR
Kang et al[93]	2012	Single institution retrospective	202	35 (NCCN)	Gemcitabine based chemoradiation	91%	87%	26.3
Stokes et al[81]	2011	Single institution retrospective	170	40 (MDA)	Capecitabine-based	46%	75%	23
					Chemoradiation
Chun et al[78]	2010	Single institution retrospective	109	109 (other)	5-FU or gemcitabine based chemoradiation	100%	59%2	232
				74 received neoadjuvant2
McClaine et al[103]	2010	Single institution retrospective	29	29 (MDA+NCCN hybrid)	Gemcitabine based chemotherapy, chemoradiation or both	46%	67%	23.3
Landry et al[84]	2010	Randomized Phase II trial	21	21 (other)	Gemcitabine based	24%	60%	26.3
Turrini et al[89]	2009	Single institution retrospective	64	49 (MDA)	5-FU/cisplatin based chemoradiation	18%	100%	24
Katz et al[31]	2008	Single institution retrospective	160	160 (MDA)	Gemcitabine based chemotherapy, chemoradiation	41%	94%	40

¹Results for Americas Hepatopancreaticobiliary Association/Society for Surgery of the Alimentary Tract/Society of Surgical Oncology/National Comprehensive Cancer Network (AHPBA/SSAT/SSO/NCCN) definition of borderline resectable;

²Results for patients who received neoadjuvant treatment. NR: Not reported.