Changing paradigm in pancreatic cancer: from adjuvant to neoadjuvant chemoradiation

In 2016 an estimated 53,070 people will be diagnosed with pancreatic cancer and of those 41,780 will succumb to the disease (1). Traditionally, the management of pancreatic cancer has been determined based on whether the tumor was amenable to resection, was unresectable, or metastatic at presentation. To determine resectability of a tumor at the time of presentation is difficult, but is typically based on either computed tomography or magnetic resonance imaging of the tumor and its relationship to surrounding blood vessels. There are various definitions of surgical resectabilty from the Americas Hepato-Pancreato-Biliary Association (AHPBA), MD Anderson, National Comprehensive Cancer Network (NCCN) and Alliance, but the mainstay of resectability is a tumor that is free from contact of the major arterial and venous structures (2)