Treatment of Borderline Resectable Pancreatic Cancer with High Probability of R1 Resection

This protocol covers the management of pancreatic cancer in patients whose disease is classified as borderline resectable, where the probability of a margin-positive (R1) surgical resection is considered high.

Clinical Scenario

Patients with borderline resectable pancreatic cancer (BRPC) carry a high probability of an R1 resection. Because of this risk of incomplete surgical clearance, the sequencing of treatment — and the decision around whether to proceed directly to surgery — requires specific consideration.

Approach Overview

In this setting, induction therapy is favored over proceeding directly to surgery — the complete regimen, sequencing criteria, and conditions under which surgery is subsequently evaluated are detailed in the full protocol.

Treatment Goals

Following induction therapy, the clinical aim is for the patient to remain medically fit, without disease progression, and to demonstrate a decrease in CA 19-9 — at which point surgical exploration is considered.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2023.08.009

Patients with BRPC have a high probability of an R1 resection and should be considered for induction treatment [III, A].
If inclusion in a clinical trial is not feasible, induction therapy is recommended over initial surgery [II, A].
Following induction therapy, medically fit patients without disease progression and with a decrease in CA 19-9 should undergo surgical exploration, unless contraindicated [III, A].

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