Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma: Role of the Radiologist and Oncologist in the Era of Precision Medicine

Overview

Journal Diagnostics (Basel)

Specialty Radiology

Date 2021 Nov 27

PMID 34829513

Citations 8

Authors

Federica Vernuccio

Carlo Messina

Valeria Merz

Roberto Cannella

Massimo Midiri

Affiliations

Soon will be listed here.

Abstract

The incidence and mortality of pancreatic ductal adenocarcinoma are growing over time. The management of patients with pancreatic ductal adenocarcinoma involves a multidisciplinary team, ideally involving experts from surgery, diagnostic imaging, interventional endoscopy, medical oncology, radiation oncology, pathology, geriatric medicine, and palliative care. An adequate staging of pancreatic ductal adenocarcinoma and re-assessment of the tumor after neoadjuvant therapy allows the multidisciplinary team to choose the most appropriate treatment for the patient. This review article discusses advancement in the molecular basis of pancreatic ductal adenocarcinoma, diagnostic tools available for staging and tumor response assessment, and management of resectable or borderline resectable pancreatic cancer.

Citing Articles

Advancing Immunotherapy in Pancreatic Cancer: A Brief Review of Emerging Adoptive Cell Therapies.

Sherpally D, Manne A Cancers (Basel). 2025; 17(4).

PMID: 40002184 PMC: 11853216. DOI: 10.3390/cancers17040589.

Advancing Pancreatic Cancer Surgical Treatments and Proposal of New Approaches.

Cortiana V, Vallabhaneni H, Gambill J, Nadar S, Itodo K, Park C Cancers (Basel). 2024; 16(16).

PMID: 39199619 PMC: 11352325. DOI: 10.3390/cancers16162848.

Use of individualized 3D-printed models of pancreatic cancer to improve surgeons' anatomic understanding and surgical planning.

Song C, Min J, Jeong W, Kim S, Heo J, Han I Eur Radiol. 2023; 33(11):7646-7655.

PMID: 37231071 DOI: 10.1007/s00330-023-09756-0.

Interventional Radiology in the Treatment of Pancreatic Adenocarcinoma: Present and Future Perspectives.

Punzi E, Carrubba C, Contegiacomo A, Posa A, Barbieri P, De Leoni D Life (Basel). 2023; 13(3).

PMID: 36983990 PMC: 10059735. DOI: 10.3390/life13030835.

Microbiota in the Natural History of Pancreatic Cancer: From Predisposition to Therapy.

Binda C, Gibiino G, Sbrancia M, Coluccio C, Cazzato M, Carloni L Cancers (Basel). 2023; 15(1).

PMID: 36611999 PMC: 9817971. DOI: 10.3390/cancers15010001.

References

Mokdad A, Minter R, Zhu H, Augustine M, Porembka M, Wang S . Neoadjuvant Therapy Followed by Resection Versus Upfront Resection for Resectable Pancreatic Cancer: A Propensity Score Matched Analysis. J Clin Oncol. 2016; 35(5):515-522. DOI: 10.1200/JCO.2016.68.5081. View

Mellon E, Jin W, Frakes J, Centeno B, Strom T, Springett G . Predictors and survival for pathologic tumor response grade in borderline resectable and locally advanced pancreatic cancer treated with induction chemotherapy and neoadjuvant stereotactic body radiotherapy. Acta Oncol. 2016; 56(3):391-397. DOI: 10.1080/0284186X.2016.1256497. View

Neoptolemos J, Stocken D, Friess H, Bassi C, Dunn J, Hickey H . A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004; 350(12):1200-10. DOI: 10.1056/NEJMoa032295. View

McNamara M, Little M, Alexander L, Carroll L, Beasley T, Morgan D . Multireader evaluation of lesion conspicuity in small pancreatic adenocarcinomas: complimentary value of iodine material density and low keV simulated monoenergetic images using multiphasic rapid kVp-switching dual energy CT. Abdom Imaging. 2014; 40(5):1230-40. DOI: 10.1007/s00261-014-0274-y. View

Katz M, Shi Q, Ahmad S, Herman J, Marsh R, Collisson E . Preoperative Modified FOLFIRINOX Treatment Followed by Capecitabine-Based Chemoradiation for Borderline Resectable Pancreatic Cancer: Alliance for Clinical Trials in Oncology Trial A021101. JAMA Surg. 2016; 151(8):e161137. PMC: 5210022. DOI: 10.1001/jamasurg.2016.1137. View

Medrano J, Garnier J, Ewald J, Marchese U, Gilabert M, Launay S . Patient outcome according to the 2017 international consensus on the definition of borderline resectable pancreatic ductal adenocarcinoma. Pancreatology. 2019; 20(2):223-228. DOI: 10.1016/j.pan.2019.12.001. View

Varadhachary G, Tamm E, Abbruzzese J, Xiong H, Crane C, Wang H . Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006; 13(8):1035-46. DOI: 10.1245/ASO.2006.08.011. View

Beleu A, Calabrese A, Rizzo G, Capelli P, Bellini N, Caloggero S . Preoperative Imaging Evaluation after Downstaging of Pancreatic Ductal Adenocarcinoma: A Multi-Center Study. Cancers (Basel). 2019; 11(2). PMC: 6406608. DOI: 10.3390/cancers11020267. View

Pishvaian M, Blais E, Brody J, Lyons E, DeArbeloa P, Hendifar A . Overall survival in patients with pancreatic cancer receiving matched therapies following molecular profiling: a retrospective analysis of the Know Your Tumor registry trial. Lancet Oncol. 2020; 21(4):508-518. PMC: 7453743. DOI: 10.1016/S1470-2045(20)30074-7. View

10.

Oettle H, Neuhaus P, Hochhaus A, Hartmann J, Gellert K, Ridwelski K . Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013; 310(14):1473-81. DOI: 10.1001/jama.2013.279201. View

11.

Elbanna K, Jang H, Kim T . Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review. Insights Imaging. 2020; 11(1):58. PMC: 7183518. DOI: 10.1186/s13244-020-00861-y. View

12.

Palta M, Godfrey D, Goodman K, Hoffe S, Dawson L, Dessert D . Radiation Therapy for Pancreatic Cancer: Executive Summary of an ASTRO Clinical Practice Guideline. Pract Radiat Oncol. 2019; 9(5):322-332. DOI: 10.1016/j.prro.2019.06.016. View

13.

Fritz F, Skornitzke S, Hackert T, Kauczor H, Stiller W, Grenacher L . Dual-Energy Perfusion-CT in Recurrent Pancreatic Cancer - Preliminary Results. Rofo. 2016; 188(6):559-65. DOI: 10.1055/s-0042-105765. View

14.

Kim B, Kim J, Ahn S, Joo I, Choi S, Park S . CT prediction of resectability and prognosis in patients with pancreatic ductal adenocarcinoma after neoadjuvant treatment using image findings and texture analysis. Eur Radiol. 2018; 29(1):362-372. DOI: 10.1007/s00330-018-5574-0. View

15.

Ichikawa T, Haradome H, Hachiya J, Nitatori T, Ohtomo K, Kinoshita T . Pancreatic ductal adenocarcinoma: preoperative assessment with helical CT versus dynamic MR imaging. Radiology. 1997; 202(3):655-62. DOI: 10.1148/radiology.202.3.9051012. View

16.

Cassinotto C, Mouries A, Lafourcade J, Terrebonne E, Belleannee G, Blanc J . Locally advanced pancreatic adenocarcinoma: reassessment of response with CT after neoadjuvant chemotherapy and radiation therapy. Radiology. 2014; 273(1):108-16. DOI: 10.1148/radiol.14132914. View

17.

Hamdy A, Ichikawa Y, Toyomasu Y, Nagata M, Nagasawa N, Nomoto Y . Perfusion CT to Assess Response to Neoadjuvant Chemotherapy and Radiation Therapy in Pancreatic Ductal Adenocarcinoma: Initial Experience. Radiology. 2019; 292(3):628-635. DOI: 10.1148/radiol.2019182561. View

18.

Katz M, Marsh R, Herman J, Shi Q, Collison E, Venook A . Borderline resectable pancreatic cancer: need for standardization and methods for optimal clinical trial design. Ann Surg Oncol. 2013; 20(8):2787-95. PMC: 5600517. DOI: 10.1245/s10434-013-2886-9. View

19.

Park M, Klotz E, Kim M, Song S, Park S, Cha S . Perfusion CT: noninvasive surrogate marker for stratification of pancreatic cancer response to concurrent chemo- and radiation therapy. Radiology. 2008; 250(1):110-7. DOI: 10.1148/radiol.2493080226. View

20.

Merz V, Gaule M, Zecchetto C, Cavaliere A, Casalino S, Pesoni C . Targeting KRAS: The Elephant in the Room of Epithelial Cancers. Front Oncol. 2021; 11:638360. PMC: 7991835. DOI: 10.3389/fonc.2021.638360. View