In research published this week in PLoS Medicine, Jörg Kleeff from Technische Universität München, and colleagues suggest that patients with apparently locally non-resectable tumors should be included in neoadjuvant protocols. The authors systematically reviewed studies concerning the effects of neoadjuvant therapy on tumor response, toxicity, resection, and survival percentages in pancreatic cancer.

Pancreatic ductal adenocarcinoma is the fourth leading cause of cancer-related mortality and is associated with an extremely poor prognosis, with a median survival of 5-8 months. At present, the only chance for cure and prolonged survival is surgical resection. Currently approximately 10%-20% of patients are considered candidates for such resection.

The authors examined 111 studies, involving 4,394 patients, and found that a third of patients initially judged unresectable were able to undergo resection after neoadjuvant therapy. These patients were then found to have a similar survival rate to patients judged resectable before neoadjuvant treatment (the average survival time being 20.5 months after resection).

Although randomized trials are now needed to confirm this finding, they suggest that patients presenting with locally advanced/unresectable tumors should be offered neoadjuvant therapy and then re-evaluated for resection.

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Funding
No direct funding was received for this study. The authors were personally salaried by their institutions during the period of writing (though no specific salary was set aside or given for the writing of this paper). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests
The authors have declared that no competing interests exist.

Citation
Gillen S, Schuster T, Meyer zum Buschenfelde C, Friess H, Kleeff J (2010) Preoperative/Neoadjuvant Therapy in Pancreatic Cancer: A Systematic Review and Meta-analysis of Response and Resection Percentages. PLoS Med 7(4): e1000267. doi:10.1371/journal.pmed.1000267

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Jörg Kleeff
Technische Universität München
Department of Surgery
Ismaningerstrasse 22
Munich, Bavaria 81675
Germany
49 89 4140 5098
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Contact: Andrew Hyde
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44-122-346-3330
Public Library of Science