Summary of Recommendations
- In good-performance-status LAPC, the use of initial chemotherapy, followed by chemoradiation in patients with response or stable disease, is a preferred treatment.
- In poor-performance-status LAPC, aggressive therapy may not be warranted and palliative therapy is prioritized.
- In good-performance-status borderline resectable patients, neoadjuvant chemotherapy followed by chemoradiation in patients with response or stable disease is a preferred treatment. The goal is then to perform a margin-negative resection.
- The target for radiation is the GTV ± immediately adjacent lymph node regions.
- Radiation techniques should include motion management.
- The use of SBRT is an emerging form of therapy.
- Chemotherapy-alone regimens include FOLFIRINOX, gemcitabine, and gemcitabine + nab-paclitaxel. The use of FOLFIRINOX is limited to good-performance-status patients.
- Concurrent chemotherapy regimens include infusional 5-fluorouracil, capecitabine, and gemcitabine.