What is the role of neoadjuvant therapy in the treatment of pancreatic cancer?

Updated: Oct 02, 2020
  • Author: Tomislav Dragovich, MD, PhD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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The use of chemotherapy and/or radiation therapy in the neoadjuvant setting has been a source of controversy. The rationale for using neoadjuvant therapy includes the following assertions:

  1. Pancreatic cancer is a systemic disease and should be treated systemically from the start.
  2. Patients will be able to tolerate the toxic effects of chemotherapy more readily before undergoing major pancreatic resection than after
  3. The tumor will shrink with neoadjuvant therapy so resection will be less cumbersome, leading to improved overall survival.

Trials of preoperative chemoradiotherapy conducted at M.D. Anderson Cancer Center have shown median survival as high as 25 months. [66, 67] However, no form of neoadjuvant therapy in pancreatic carcinoma should be regarded as a standard form of therapy; this remains an area for clinical trial study.

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