Borderline Resectable Pancreatic Cancer (BRPC)
Pancreatic ductal adenocarcinoma (PDAC) is the third most common cause of cancer-related mortality in the United States with 41,780 projected deaths in 2016, and is expected to rise to the second leading cause by 2030. This malignancy is characteristically highly aggressive and treatment-resistant, with nearly 80% of PDAC patients presenting with either metastatic or inoperable disease at the time of diagnosis. The minority of patients with localized, non-metastatic disease who are potential surgical candidates may be divided into two categories:
- Those who have clearly resectable disease at initial diagnosis
- Those with borderline resectable pancreatic cancer (BRPC)
BRPC represents an increasingly recognized, distinct clinical entity characterized by primary tumor involving surrounding vasculature with a high risk for margin-positive resection if resected de novo — that is, surgically removed in newly diagnosed patients.
Neoadjuvant therapy (treatment before surgery) is often considered for patients with both resectable and borderline resectable disease. While the most common treatment paradigm for patients with clearly resectable tumors entails immediate surgery followed by adjuvant therapy (treatment post-surgery), neoadjuvant strategies in this context may be helpful to eradicate any micrometastatic disease and to identify suitable candidates most likely to benefit from surgery.
Select studies have explored this paradigm in patients with up-front resectable disease, with promising results. Meanwhile, administration of neoadjuvant therapy for patients with BRPC is also recommended to improve the likelihood of margin-negative (R0) resection, a significant prognostic indicator for long-term survival or cure.
The following is syndicated content from the National Cancer Institute (NCI)