Preoperative treatments in borderline resectable and locally advanced pancreatic cancer: Current evidence and new perspectives

Surgery is the only curative treatment for non-metastatic pancreatic adenocarcinoma, but less than 20 % of patients present a resectable disease at diagnosis. Treatment strategies and disease definition for borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) vary in the different cancer centres. Preoperative chemotherapy (CT) is the standard of care for both BRPC and LAPC patients, however literature data are still controversial concerning the type, dose and duration of the different CT regimens, as well as regarding the integration of radiotherapy (RT) or chemoradiation (CRT) in the therapeutic algorithm. In this unsettled debate, we aimed at focusing on the therapeutic regimens currently in use and relative literature data, to report international trials comparing the available therapeutic options or explore the introduction of new pharmacological agents, and to analyse possible new scenarios in microenvironment evaluation before and after neoadjuvant therapies or in patients’ selection at a molecular level. [Display omitted] •Less than 20 % of pancreatic cancer patients have a resectable disease at diagnosis.•BRPC and LAPC patients need a preoperative treatment, including CT and possibly RT.•Treatment algorithms are still debated and vary in the different cancer centres.•New therapeutic options and microenvironment-targeted agents are being evaluated.•Consultation at high-volume centres and inclusion in clinical trials are advisable.