Medical Oncology Unit, Cancer Institute "Giovanni Paolo II", Bari, Italy.
Department of Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Crit Rev Oncol Hematol. 2017 Mar;111:152-165. doi: 10.1016/j.critrevonc.2017.01.015. Epub 2017 Feb 4.
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.
在进行术前分期后，可切除胰腺腺癌（PDAC）的治疗包括手术和辅助治疗，前者是初始治疗选择，后者旨在降低远处转移（化疗）和局部区域失败（放化疗）的发生率。在此，我们对 PDAC 的多模式治疗作用以及与当前更积极的联合化疗方案、靶向治疗和最近的免疫治疗方法相关的新机会进行了批判性综述。此外，还将分析能够帮助临床医生选择最佳治疗策略的病理标志物和临床特征。最后，将主要讨论初始可切除疾病的新辅助治疗作用，适用于肿瘤具有形态学但不具有临床或生物学可切除性标准的患者。根据这些研究的结果，今天多学科方法可以为这些患者提供最佳治疗方案。
