In 30%–40% of patients with pancreatic cancer, the tumour is unresectable due to vascular involvement — a presentation classified as locally advanced pancreatic cancer (LAPC). The purpose of conversion (or induction) therapy in this setting is to induce tumour downsizing to facilitate resection in patients with initial unresectable disease.
This protocol applies after conversion (induction) therapy — up to 6 months of combination chemotherapy with FOLFIRINOX or GN — which targeted significant decrease in CA 19-9 level, clinical improvement, and tumour downstaging, with resectability re-evaluated every 2–3 months.
When those re-evaluation criteria are met, the question of surgical intervention is formally revisited and this next-step protocol enters consideration.
The approach at this stage centres on surgical exploration for resection.
The complete structured protocol — including the specific criteria, workup, and decision pathway — is available in full via the link below.In 30%–40% of patients, the tumour is unresectable due to vascular involvement.
In LAPC, the purpose of conversion (or induction) therapy is to induce tumour downsizing to facilitate resection in patients with initial unresectable disease.
Exploration for resection could be discussed if there is a significant decrease in CA 19-9 level, clinical improvement and tumour downstaging [IV, B].
DOI: 10.1016/j.annonc.2023.08.009
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