Management of unresectable, locally advanced pancreatic adenocarcinoma

• M. Salgado ^[6] ; S. Arévalo ^[1] ; O. Hernando ^[2] ; A. Martínez ^[3] ; R. Yaya ^[4] ; M. Hidalgo ^[5]
  1. [1] Hospital Universitario de Donostia

     Hospital Universitario de Donostia

     San Sebastián, España

     
  2. [2] Hospital Universitario HM Sanchinarro

     Hospital Universitario HM Sanchinarro

     Madrid, España

     
  3. [3] Hospital del Mar

     Hospital del Mar

     Barcelona, España

     
  4. [4] Instituto Valenciano de Oncologia

     Instituto Valenciano de Oncologia

     Valencia, España

     
  5. [5] Harvard Medical School

     Harvard Medical School

     City of Boston, Estados Unidos

     
  6. [6] Complejo Hospitalario Universitario de Orense, España

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 20, Nº. 2 (February 2018), 2018, págs. 113-118
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • The diagnosis of unresectable locally advanced pancreatic adenocarcinoma (LAPC) requires confirmation, through imaging tests, of the unfeasibility of achieving a complete surgical resection, in the absence of metastatic spread. The increase in overall survival (OS), together with an appropriate symptom management is the therapeutic target in LAPC, maintaining an acceptable quality of life and, if possible, increasing the time until the appearance of metastasis. Chemoradiation (CRT) improves OS compared to best support treatment or radiotherapy (RT) but with greater toxicity. No significant increase in OS has been achieved with CRT when compared to chemotherapy (QT) alone in patients without disease progression after four months of treatment with QT. However, a significantly better local control, that is, a significant increase in the time to disease progression was associated with this approach. The greater effectiveness of the schemes FOLFIRINOX and gemcitabine (Gem) + Nab-paclitaxel compared to gemcitabine alone, has been extrapolated from metastatic disease to LAPC, representing a possible alternative for patients with good performance status (ECOG 0–1). In the absence of randomized clinical trials, Gem is the standard treatment in LAPC. If disease control is achieved after 4–6 cycles of QT, the use of CRT for consolidation can be considered an option vs QT treatment maintenance. Capecitabine has a better toxicity profile and effectiveness compared to gemcitabine as a radiosensitizer. After local progression, and without evidence of metastases, treatment with RT or CRT, in selected patients, can support to maintain the regional disease control.