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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Oct 15, 2015; 7(10): 241-249
Published online Oct 15, 2015. doi: 10.4251/wjgo.v7.i10.241
Management of borderline resectable pancreatic cancer
Amit Mahipal, Jessica Frakes, Sarah Hoffe, Richard Kim
Amit Mahipal, Richard Kim, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
Jessica Frakes, Sarah Hoffe, Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Richard Kim, MD, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive FOB-2, Tampa, FL 33612, United States. richard.kim@moffitt.org
Telephone: +1-813-7451277 Fax: +1-813-7457229
Received: April 15, 2015
Peer-review started: April 16, 2015
First decision: July 1, 2015
Revised: July 7, 2015
Accepted: August 10, 2015
Published online: October 15, 2015
Abstract

Pancreatic cancer is the fourth most common cause of cancer death in the United States. Surgery remains the only curative option; however only 20% of the patients have resectable disease at the time of initial presentation. The definition of borderline resectable pancreatic cancer is not uniform but generally denotes to regional vessel involvement that makes it unlikely to have negative surgical margins. The accurate staging of pancreatic cancer requires triple phase computed tomography or magnetic resonance imaging of the pancreas. Management of patients with borderline resectable pancreatic cancer remains unclear. The data for treatment of these patients is primarily derived from retrospective single institution experience. The prospective trials have been plagued by small numbers and poor accrual. Neoadjuvant therapy is recommended and typically consists of chemotherapy and radiation therapy. The chemotherapeutic regimens continue to evolve along with type and dose of radiation therapy. Gemcitabine or 5-fluorouracil based chemotherapeutic combinations are administered. The type and dose of radiation vary among different institutions. With neoadjuvant treatment, approximately 50% of the patients are able to undergo surgical resections with negative margins obtained in greater than 80% of the patients. Newer trials are attempting to standardize the definition of borderline resectable pancreatic cancer and treatment regimens. In this review, we outline the definition, imaging requirements and management of patients with borderline resectable pancreatic cancer.

Keywords: Pancreatic cancer, Surgery, Chemotherapy, Radiation, Borderline

Core tip: The diagnosis and treatment of borderline resectable pancreatic cancer (BRPC) remains unclear. The definition of BRPC is not uniform and generally refers to regional blood vessel involvement by the tumor. Recent attempts have been made to standardize the definition of BRPC. Neoadjuvant therapy is recommended in the hopes of obtaining negative surgical margins and consists of chemotherapy and radiation therapy. Data for therapeutic approaches is primarily derived from single institution retrospective series. In this article, we review the definition, imaging modalities for diagnosis and treatment of patients with BRPC.