Barcellini Amelia, Peloso Andrea, Pugliese Luigi, Vitolo Viviana, Cobianchi Lorenzo
National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.
Divisions of Transplantation and Visceral Surgery, Department of Surgery, University of Geneva, Geneva, Switzerland.
Onco Targets Ther. 2020 Dec 10;13:12705-12720. doi: 10.2147/OTT.S220971. eCollection 2020.
Pancreatic ductal adenocarcinoma (PDAC) is one of the major causes of death in the Western world, and it is estimated to become the second leading cause of tumour-related mortality in the next 10 years. Among pancreatic cancers, ductal adenocarcinomas are by far the most common, characterised by a challenging diagnosis due to the lack of initial and pathognomonic clinical signs. In this scenario, non-metastatic locally advanced pancreatic cancer (LAPC) accounts for a large proportion of all new pancreatic ductal adenocarcinoma diagnoses. There is no consensus on a common definition of LAPC. Still, it usually includes tumours that are not resectable due to vascular involvement. As of today, treatment is limited, and the prognosis is very unfavourable. Curative-intent surgery remains the gold-standard even if often jeopardized by vascular involvement. Continuing progress in our understanding of LAPC genetics and immunology will permit the development of different treatments, targeted or combined, including radiation therapy, hadrontherapy, targeted immunotherapies or new chemotherapies. A multidisciplinary approach combining various fields of expertise is essential in aiming to limit disease progression as well as patient outcome. Using a narrative literature review approach, the manuscript explores the most up-to-date knowledge concerning locally advanced pancreatic ductal adenocarcinoma management.
胰腺导管腺癌（PDAC）是西方世界主要的死亡原因之一，预计在未来10年将成为肿瘤相关死亡的第二大主要原因。在胰腺癌中，导管腺癌是迄今为止最常见的类型，由于缺乏初始的特征性临床症状，其诊断具有挑战性。在这种情况下，非转移性局部晚期胰腺癌（LAPC）在所有新诊断的胰腺导管腺癌中占很大比例。对于LAPC的统一定义尚无共识。不过，它通常包括因血管受累而无法切除的肿瘤。截至目前，治疗方法有限，预后非常不利。即使经常因血管受累而受到影响，根治性手术仍然是金标准。我们对LAPC遗传学和免疫学的理解不断进步，将有助于开发不同的治疗方法，包括靶向治疗或联合治疗，如放射治疗、强子治疗、靶向免疫治疗或新的化疗方法。结合各个专业领域的多学科方法对于限制疾病进展以及改善患者预后至关重要。本文采用叙述性文献综述方法，探讨了有关局部晚期胰腺导管腺癌管理的最新知识。
