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- W3080716616 abstract ": Pancreatic ductal adenocarcinoma (PDAC) remains among the most lethal cancers due to late presentation, early systemic metastases, and general resistance to modern systemic therapies. Defining features of PDAC include a high rate of KRAS mutation with a significant propensity for both local invasion and distant metastases. Precursor lesions for PDAC include pancreatic intraepithelial neoplasia 1, 2, and 3 (low, intermediate, and high-grade, respectively), as mutational burden increases with increasing grade. Additional mutations, such as CDKN2A, p53, and SMAD4 are increasingly found in higher grade and more advanced lesions. Approximately 70% of PDAC tumors are found in the head and uncinate process, and 30% in the neck, body, and tail. Workup of a pancreatic mass includes laboratory testing including CEA and CA 19-9, and high-resolution cross-sectional imaging. Endoscopic ultrasound (EUS), with or without endoscopic retrograde cholangiopancreatography (ERCP) are used to visualize the tumor, obtain fine-needle aspirate (FNA) or core biopsies, and place a biliary stent if needed. Approximately 15–20% of patients with PDAC present with resectable disease, which conventionally includes disease without involvement of critical vascular structures, or venous abutment less than 180 degrees, and are candidates for surgical intervention. Additional involvement of adjacent vascular structures constitutes the more advanced entities, including borderline resectable and locally advanced unresectable disease. In this review, we discuss recent advances in the treatment of localized PDAC, including upfront resectable, and locally advanced, tumors, with a focus on evidence-based, multimodal, strategies in the treatment of this disease." @default.
- W3080716616 created "2020-09-01" @default.
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- W3080716616 date "2020-08-01" @default.
- W3080716616 modified "2023-09-27" @default.
- W3080716616 title "Systemic and targeted therapies for pancreatic ductal adenocarcinoma" @default.
- W3080716616 doi "https://doi.org/10.21037/apc-2020-pda-06" @default.
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