Pancreatic cancer has the worse prognosis among solid tumors, with an overall 5-yr survival rate lower than 10%. Unfortunately, more than 50% of patients with pancreatic cancer have overt distant metastases at diagnosis, and cancer invasion of peripancreatic vessels prevent resection in about 25% of the remaining patients. Therefore, surgery - the only curative treatment option - is reserved for only a subset of patients, carefully selected by preoperative imaging. Even in patients receiving surgery, long-term results are disappointing since cancer will recur in about 80% of these patients.
Due to the high rates of systemic and/or local recurrence, various sequences of chemotherapy and radiotherapy - adjuvant or neo-adjuvant - are administered to pancreatic cancer patients who undergo curative intent surgery. Prospectively validated phase III data have demonstrated that adjuvant therapies improve survival, but up to one-third of eligible patients fail to receive such treatments -either due to inadequate recovery or postoperative complications after a major resection. Therefore, administration of chemotherapy and/or radiotherapy in the neo-adjuvant setting has been gaining traction in patients with operable pancreatic cancer. Several retrospective studies and a few prospective randomized trials suggest better outcomes with neoadjuvant treatment sequencing as opposed to upfront surgery (followed by adjuvant chemotherapy), but there is still no consensus on patient selection and optimal treatment sequencing.
Further, prospectively validated phase III data are lacking in terms of the optimal therapeutic strategy in the neoadjuvant setting - the ideal chemotherapy program, the duration of such therapy, the role of precision/targeted therapies and the role of radiotherapy.
This series will focus on the different aspects of neoadjuvant therapy for localized pancreatic cancer. We welcome the submission of Original Research, Reviews, Mini-Reviews, Methods, and Clinical Trial articles.
Keywords: Pancreatic Cancer, Neoadjuvant, Surgery, Chemotherapy, Radiotherapy
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