JLE

Hépato-Gastro & Oncologie Digestive

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Management of unresectable localized pancreatic adenocarcinoma: the state of play in 2022 Volume 30, issue 1, January 2023

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Authors
1 APHM, Hôpital de la Timone, Service d’oncologie digestive et hépato-gastro-entérologie, 264 rue saint Pierre, F-13385 Marseille Cedex 05
2 Institut Paoli Calmettes, Servie d'oncologie médicale, 232 Boulevard de Sainte-Marguerite, 13009 Marseille
* Correspondance : B. de Rauglaudre

Pancreatic ductal adenocarcinoma (PDAC) is one of the tumor with the worst prognosis. Although survival improvement with "modern" therapeutics remains poor compared to other tumors, the progress of radiology and the multidisciplinary consensus have allowed to identify subgroups of non-metastatic pancreatic cancer according to loco-regional vascular invasion : resectable, borderline resectable and locally advanced. That new definition guides the therapeutic sequences. Recent data have highlighted the impact of preoperative therapy, notably chemotherapy, for borderline or locally advanced AP to obtain optimal carcinologic surgery, which is currently the only potentially curative treatment for PDAC. However, many questions remain unadressed, for example, what is the best therapeutic sequence, when radiotherapy should be used, the clinical and biological selection of patients and the evaluation of the response to treatment. These gaps are under intense investigations worldwide, and with the incidence rising of that terrible disease, non resectable PDAC management represents a real hot topic. In this review, we will describe the recent advances in borderline or locally advanced unresectable PDAC and highlight the challenges for the coming years.