Management of borderline resectable pancreatic cancer

Table 1 Criteria for resectability

	NCCN	AHPBA/SSAT/SSO	MD Anderson	Intergroup (Alliance)
Celiac artery	No abutment for pancreatic head cancer. For body/tail, ≤ 180° contact	No abutment or encasement	Abutment	Tumor-vessel interface < 180° of vessel wall circumference
CHA	Solid tumor contact ≤ 180° allowing for reconstruction	Abutment or short segment encasement	Abutment or short-segment encasement	Reconstructable short-segment interface of any degree
SMA	Solid tumor contact ≤ 180°	Abutment	Abutment	Tumor-vessel wall interface < 180° of vessel wall circumference
SMV/PV	Solid tumor contact > 180° or contact of ≤ 180° with contour irregularity or thrombosis allowing for safe reconstruction	Occlusion	Occlusion	Tumor-vessel interface ≥ 180° of vessel wall circumference and/or reconstructible occlusion

CHA: Common hepatic artery; SMA: Superior mesenteric artery; SMV: Superior mesenteric vein; PV: Portal vein; NCCN: National Comprehensive Cancer Network; AHPBA/SSAT/SSO: Americas Hepato-Pancreato-Biliary Association/Society for Surgery of the Alimentary Tract/Society of Surgical Oncology.

Table 2 Selected neoadjuvant studies for borderline resectable pancreatic cancer

Ref.	Study type	n	Regimen	Resection	R0 resection	Median OS(resected patients)	Median OS(all patients)	Definition
Katz et al[40]	Retrospective	84	5-FU, paclitaxel, gemcitabine or capecitabine + RT; Gemcitabine based chemotherapy	38%	97%	40 mo	21	MDA
Turrini et al[70]	Retrospective	49	5-FU/cis + RT 45 Gy for 5 wk	18%	100%	24 mo	14 mo	MDA
Chun et al[71]	Retrospective	74	5-FU or gem + RT	100%	59%	23	23	Other
Stokes et al[41]	Retrospective	40	Capecitabine + RT	46%	75%	23	12	MDA
Katz et al[37]	Retrospective	115	Gem followed by gem or 5-FU or capecitabine + RT; Gem or 5-FU or capecitabine + RT	70%	95%	33	22	NCCN
Mellon et al[45]	Retrospective	110	GTX X 3 cycles followed by SBRT	51%	96%	19	34	NCCN
Landry et al[39]	Randomized phase II	21	Gem + RT; Gem/cis/5-FU followed by 5-FU/RT	24%	100%	26	19.4 mo; 13.4 mo	Other
Lee et al[44]	Prospective trial	18	Gem/capecitabine X 3-6 cycles	61%	82%	23	16	NCCN
Kim et al[42]	Phase II study	39	Gem/Ox + RT	63%	84%	25	18	NCCN
Motoi et al[43]	Phase II study	16	Gem/S1 X 2 cycles	NA	87%	NA	18	MDA
Takahashi et al[46]	Prospective	80	Gem + RT followed by Gem	54%	98%	NA	NA	Other

NCCN: National Comprehensive Cancer Network; MDA: MD Anderson; 5-FU: 5-flurouracil; NA: Not available; RT: Radiation therapy.