Pancreatic cancer is currently the 4th cause of cancer death in Europe as well as in the US, where there have been 55,440 new cases and an estimated 44,330 deaths will occur in 2018. Despite different therapeutic strategies currently available, the overall 5-year survival remains at 8%. Moreover, due to the complex extensions that the tumor can have, even when not metastatic, only 10–20% of patients are eligible for upfront surgery with a 5-year survival raising to 10–30%.
The current trend for non-metastatic pancreatic adenocarcinoma is to differentiate three categories based on vascular involvement assessed by preoperative imaging: resectable (15%), borderline resectable (20%) and locally advanced disease (35%). Different strategies and combinations of surgery and neoadjuvant and/or adjuvant therapies are currently investigated for these categories. Although neoadjuvant therapies have shown beneficial effects for pancreatic cancer treatment, currently, treatment sequencing and specific elements of neoadjuvant treatments are still under investigation.
The benefits of a neoadjuvant approach may consist in selecting the patient with a less aggressive biological disease, controlling the micrometastatis and avoiding the risk of drop-outs from adjuvant treatment related to post-operative complications and/or decline in the functional status. Furthermore, the use of neoadjuvant chemoradiation is associated with higher R0 resection rates compared with the surgery-first approach and recent data have shown an improvement of the Overall Survival in the group of patients treated by Neoadjuvant Therapy.
However, the choice of neoadjuvant treatment is still a matter of debate and the choice is mainly led by the patient performance status and the single center preference. Therefore, this Research Topic will investigate the tolerance of different treatments and how neoadjuvant influences survival, surgical resectability, and postoperative outcomes in Pancreatic Ductal Adenocarcinoma. We welcome the submission of Original Research, Reviews, Mini-Reviews, Methods, and Clinical Trial articles.