What are the treatment guidelines for unresectable and/or metastatic pancreatic tumors?

Updated: Feb 12, 2019
  • Author: Cameron K Tebbi, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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NCCN recommendations for the treatment of unresectable and/or metastatic pancreatic tumors include the following [103] :

  • Limited hepatic metastases: Complete resection of primary tumor and metastases with curative intent; noncurative debulking surgery in select cases

  • Asymptomatic unresectable disease: For select patients with low tumor burden and stable disease, consider observation with marker assessment and imaging every 3-12 months until significant disease progression occurs; lanreotide or octreotide can be considered

  • Symptomatic unresectable disease: Octreotide or lanreotide; everolimus or sunitinib; or cytotoxic chemotherapy

  • Hepatic-directed therapies include cytoreductive surgery or ablative therapy; bland hepatic arterial embolization, radioembolization, and chemoembolization are additional options but the optimal embolization technique has not been determined

  • Liver transplantation is investigational and not recommended as routine care

The European Neuroendocrine Tumor Society (ENETS) guidelines are generally similar to those of the NCCN, with the following major variances [116] :

  • To justify surgery of liver metastases in patients with nonfunctioning tumors, reduction of at least 90% of the tumor mass should be expected

  • Liver transplantation is an option in patients without extrahepatic metastases and low proliferation rate when other options have failed

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