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Review
. 2022 Dec 28:14:3589-3598.
doi: 10.2147/CMAR.S340719. eCollection 2022.

Borderline Resectable Pancreatic Cancer: Challenges for Clinical Management

Ali Fawaz  1 , Omar Abdel-Rahman  1
Affiliations
Review

Borderline Resectable Pancreatic Cancer: Challenges for Clinical Management

Ali Fawaz et al. Cancer Manag Res. .

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) remains a significant worldwide health problem with a poor prognosis. A borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) is a tumor with limited vascular involvement that is technically resectable but with a high risk of positive margins (R1 resection).

Objective: To identify the current challenges that exist in the management of BR-PDAC.

Methods: A review of the literature was conducted to identify articles discussing the definitions and management of BR-PDAC.

Key findings: Several anatomic definitions of BR-PDAC exist, and there is significant heterogeneity in their utilization across published trials. To improve the odds of a margin negative (R0) resection, a neoadjuvant treatment approach involving chemotherapy with or without radiation is currently preferred. While supporting the efficacy of a neoadjuvant approach in BR-PDAC, the largest published randomized trials have utilized older gemcitabine-based regimens. Recently published Phase II evidence and meta-analyses have supported the use of modern multi-agent regimens such as FOLFIRINOX. The utility of adding radiation to a chemotherapy backbone remains in question. Due to remnant fibrosis and edema following neoadjuvant therapy, accurately selecting patients for resection based on a restaging CT scan is challenging. Furthermore, the role of adjuvant therapy in BR-PDAC patients receiving neoadjuvant therapy needs to be defined.

Conclusion: Though progress has been made, the optimal management of BR-PDAC is uncertain. Phase III trials utilizing modern chemotherapeutic regimens are needed to establish a standard of care.

Keywords: borderline resectable disease; neoadjuvant chemotherapy; pancreatic cancer; surgery.

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Conflict of interest statement

Dr Omar Abdel-Rahman is part of the advisory board for Amgen, Eisai, Ipsen, Roche, Lilly, and Bayer, outside the submitted work. The authors report no other conflicts of interest in this work.

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