Copyright ©The Author(s) 2021.
World J Gastroenterol. Jul 21, 2021; 27(27): 4383-4394
Published online Jul 21, 2021. doi: 10.3748/wjg.v27.i27.4383
Table 1 Opportunities for personalized care during neoadjuvant therapy for pancreatic cancer
Anatomic stagingCharacterization of local extent and vascular involvement of tumorLocally advanced/unresectable; Borderline resectable; Potentially resectableAnatomic staging can influence the recommended duration and components (e.g., preoperative radiation) of neoadjuvant therapy
Molecular stagingIdentification of tumor/germline genetic and molecular markersBRCA mutations; Mismatch repair-deficiency; Molecular markersSpecific tumor/germline mutations may identify opportunity for targeted therapies (e.g., immunotherapy, PARP inhibitors) Standard chemotherapy may be influenced by molecular markers (e.g., resistance/sensitivity to traditional flouropyridamine or gemcitabine-based therapy)
Dynamic stagingMeasuring biochemical, radiographic, and histologic response of the tumor to neoadjuvant therapyCarbohydrate antigen 19-9; Response evaluation criteria in solid tumors response; Pathologic responseMeasuring response to neoadjuvant therapy can influence treatment strategies (e.g., changing neoadjuvant regimen, use of radiation, recommendations for adjuvant therapy)
Table 2 Anatomic staging of localized pancreatic ductal adenocarcinoma as defined by the 2008 AHPBA/SSO/SSAT consensus guidelines
ResectableBorderlineLocally advanced
SMV-PVUninvolved with tumor with clear fat planes around vesselsAbutment, encasement, or occlusion of short segment of veinOcclusion, thrombosis, or encasement extending several centimeters
SMAUninvolvedTumor abutment < 180°Tumor abutment > 180° (encasement) or thrombosis of artery
Celiac axisUninvolvedUninvolved celiac axis; short segment encasement or abutment of common hepatic artery may be amenable to resection and reconstructionAbutment or encasement of celiac axis indicates unresectability