White paper on pancreatic ductal adenocarcinoma from society of abdominal radiology's disease-focused panel for pancreatic ductal adenocarcinoma: Part I, AJCC staging system, NCCN guidelines, and borderline resectable disease

doi:10.1007/s00261-019-02289-5

Review

. 2020 Mar;45(3):716-728.

doi: 10.1007/s00261-019-02289-5.

White paper on pancreatic ductal adenocarcinoma from society of abdominal radiology's disease-focused panel for pancreatic ductal adenocarcinoma: Part I, AJCC staging system, NCCN guidelines, and borderline resectable disease

Affiliations

¹ Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA. nkulkarni@mcw.edu.
² Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
³ Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA.
⁴ Department of Radiology, LSU Health - Shreveport Ochsner-LSU Health - Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
⁵ Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
⁶ Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Shapiro 4, Boston, MA, 02215-5400, USA.
⁷ Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
⁸ Department of Radiology, Columbia University Medical Center, 622 W 168th St, PH1-317, New York, NY, 10032, USA.
⁹ Department of Radiology, Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 75014, Paris, France.
¹⁰ Abdominal Imaging Department, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX, 77030-400, USA.
¹¹ Department of Radiology, University of Arizona College of Medicine, 1501 N. Campbell Ave., P.O. Box 245067, Tucson, AZ, 85724, USA.
¹² IRCCS SDN, Naples, Italy.
¹³ Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA.

PMID: 31748823
DOI: 10.1007/s00261-019-02289-5

Review

White paper on pancreatic ductal adenocarcinoma from society of abdominal radiology's disease-focused panel for pancreatic ductal adenocarcinoma: Part I, AJCC staging system, NCCN guidelines, and borderline resectable disease

Naveen M Kulkarni et al. Abdom Radiol (NY). 2020 Mar.

. 2020 Mar;45(3):716-728.

doi: 10.1007/s00261-019-02289-5.

Authors

Affiliations

¹ Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA. nkulkarni@mcw.edu.
² Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
³ Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA.
⁴ Department of Radiology, LSU Health - Shreveport Ochsner-LSU Health - Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
⁵ Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
⁶ Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Shapiro 4, Boston, MA, 02215-5400, USA.
⁷ Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
⁸ Department of Radiology, Columbia University Medical Center, 622 W 168th St, PH1-317, New York, NY, 10032, USA.
⁹ Department of Radiology, Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 75014, Paris, France.
¹⁰ Abdominal Imaging Department, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX, 77030-400, USA.
¹¹ Department of Radiology, University of Arizona College of Medicine, 1501 N. Campbell Ave., P.O. Box 245067, Tucson, AZ, 85724, USA.
¹² IRCCS SDN, Naples, Italy.
¹³ Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA.

PMID: 31748823
DOI: 10.1007/s00261-019-02289-5

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive gastrointestinal malignancy with a poor 5-year survival rate. Accurate staging of PDAC is an important initial step in the development of a stage-specific treatment plan. Different staging systems/consensus statements convened by different societies and academic practices are currently used. The most recent version of the American Joint Committee on Cancer (AJCC) tumor/node/metastases (TNM) staging system for PDAC has shifted its focus from guiding management to assessing prognosis. In order to preoperatively define the resectability of PDAC and to guide management, additional classification systems have been developed. The National Comprehensive Cancer Network (NCCN) guidelines, one of the most commonly used systems, provide recommendations on the management and the determination of resectability for PDAC. The NCCN divides PDAC into three categories of resectability based on tumor-vessel relationship: 'resectable,' 'borderline resectable,' and 'unresectable'. Among these, the borderline disease category is of special interest given its evolution over time and the resulting variations in the definition and the associated recommendations for management between different societies. It is important to be familiar with the evolving criteria, and treatment and follow-up recommendations for PDAC. In this article, the most current AJCC staging (8th edition), NCCN guidelines (version 2.2019-April 9, 2019), and challenges and controversies in borderline resectable PDAC are reviewed.

Keywords: AJCC staging; Borderline resectable pancreatic adenocarcinoma; NCCN; Pancreatic ductal adenocarcinoma.

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References

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1. NCCN clinical practice guidelines in oncology - Pancretic adenocarcinoma. V1.2019 - November 8, 2018. https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf . Published Accessed on 1/20/2019.
1. Saka B, Balci S, Basturk O, Bagci P, Postlewait LM, Maithel S, Knight J, El-Rayes B, Kooby D, Sarmiento J, Muraki T, Oliva I, Bandyopadhyay S, Akkas G, Goodman M, Reid MD, Krasinskas A, Everett R, Adsay V. Pancreatic Ductal Adenocarcinoma is Spread to the Peripancreatic Soft Tissue in the Majority of Resected Cases, Rendering the AJCC T-Stage Protocol (7th Edition) Inapplicable and Insignificant: A Size-Based Staging System (pT1: </=2, pT2: > 2- </=4, pT3: > 4 cm) is More Valid and Clinically Relevant. Ann Surg Oncol 2016;23(6):2010-2018. https://doi.org/10.1245/s10434-016-5093-7 - DOI

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[1] Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017;67(1):7-30. https://doi.org/10.3322/caac.21387 - DOI

[2] Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017;67(1):7-30. https://doi.org/10.3322/caac.21387 - DOI

[3] AJCC Cancer Staging Manual. Edge SB et al. New York: Springer. 2010.

[4] AJCC Cancer Staging Manual. Edge SB et al. New York: Springer. 2010.

[5] AJCC Cancer Staging Manual. Eighth Edition. Amin MB et al. New York: Springer 2017.

[6] AJCC Cancer Staging Manual. Eighth Edition. Amin MB et al. New York: Springer 2017.

[7] NCCN clinical practice guidelines in oncology - Pancretic adenocarcinoma. V1.2019 - November 8, 2018. https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf . Published Accessed on 1/20/2019.

[8] NCCN clinical practice guidelines in oncology - Pancretic adenocarcinoma. V1.2019 - November 8, 2018. https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf . Published Accessed on 1/20/2019.

[9] Saka B, Balci S, Basturk O, Bagci P, Postlewait LM, Maithel S, Knight J, El-Rayes B, Kooby D, Sarmiento J, Muraki T, Oliva I, Bandyopadhyay S, Akkas G, Goodman M, Reid MD, Krasinskas A, Everett R, Adsay V. Pancreatic Ductal Adenocarcinoma is Spread to the Peripancreatic Soft Tissue in the Majority of Resected Cases, Rendering the AJCC T-Stage Protocol (7th Edition) Inapplicable and Insignificant: A Size-Based Staging System (pT1: </=2, pT2: > 2- </=4, pT3: > 4 cm) is More Valid and Clinically Relevant. Ann Surg Oncol 2016;23(6):2010-2018. https://doi.org/10.1245/s10434-016-5093-7 - DOI

[10] Saka B, Balci S, Basturk O, Bagci P, Postlewait LM, Maithel S, Knight J, El-Rayes B, Kooby D, Sarmiento J, Muraki T, Oliva I, Bandyopadhyay S, Akkas G, Goodman M, Reid MD, Krasinskas A, Everett R, Adsay V. Pancreatic Ductal Adenocarcinoma is Spread to the Peripancreatic Soft Tissue in the Majority of Resected Cases, Rendering the AJCC T-Stage Protocol (7th Edition) Inapplicable and Insignificant: A Size-Based Staging System (pT1: </=2, pT2: > 2- </=4, pT3: > 4 cm) is More Valid and Clinically Relevant. Ann Surg Oncol 2016;23(6):2010-2018. https://doi.org/10.1245/s10434-016-5093-7 - DOI

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White paper on pancreatic ductal adenocarcinoma from society of abdominal radiology's disease-focused panel for pancreatic ductal adenocarcinoma: Part I, AJCC staging system, NCCN guidelines, and borderline resectable disease

Affiliations

White paper on pancreatic ductal adenocarcinoma from society of abdominal radiology's disease-focused panel for pancreatic ductal adenocarcinoma: Part I, AJCC staging system, NCCN guidelines, and borderline resectable disease

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