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Multimodal treatment of resectable pancreatic ductal adenocarcinoma. 2017
Nicola Silvestris, and
Oronzo Brunetti, and
Enrico Vasile, and
Francesco Cellini, and
Ivana Cataldo, and
Valeria Pusceddu, and
Monica Cattaneo, and
Stefano Partelli, and
Mario Scartozzi, and
Giuseppe Aprile, and
Andrea Casadei Gardini, and
Alessio Giuseppe Morganti, and
Vincenzo Valentini, and
Aldo Scarpa, and
Massimo Falconi, and
Angela Calabrese, and
Vito Lorusso, and
Michele Reni, and
Stefano Cascinu
Medical Oncology Unit, Cancer Institute "Giovanni Paolo II", Bari, Italy. Electronic address: n.silvestris@oncologico.bari.it.
After a timing preoperative staging, treatment of resectable pancreatic adenocarcinoma (PDAC) includes surgery and adjuvant therapies, the former representing the initial therapeutic option and the latter aiming to reduce the incidence of both distant metastases (chemotherapy) and locoregional failures (chemoradiotherapy). Herein, we provide a critical overview on the role of multimodal treatment in PDAC and on new opportunities related to current more active poli-chemotherapy regimens, targeted therapies, and the more recent immunotherapy approaches. Moreover, an analysis of pathological markers and clinical features able to help clinicians in the selection of the best therapeutic strategy will be discussed. Lastly, the role of neoadjuvant treatment of initially resectable disease will be considered mostly in patients whose malignancy shows morphological but not clinical or biological criteria of resectability. Depending on the results of these investigational studies, today a multidisciplinary approach can offer the best address therapy for these patients.
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