Pancreatic Cancer Management | Insights from REDISCOVER Guidelines
In this video, Dr. Gunjan Desai, a pancreatic surgeon in Mumbai, at Lilavati Hospital, provides an in-depth discussion on managing borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC). Pancreatic cancer remains a challenging malignancy with a high mortality rate, and the approach to BRPC and LAPC requires a multidisciplinary strategy to optimize outcomes. The latest REDISCOVER 2024 guidelines have introduced significant updates in the management of these conditions, focusing on neoadjuvant therapy, surgical considerations, and systemic treatment strategies.
Dr. Desai begins by explaining the key differences between borderline resectable and locally advanced pancreatic cancer. BRPC is defined by limited vascular involvement of the superior mesenteric vein (SMV), portal vein (PV), or nearby arteries, making surgery possible after appropriate downstaging. LAPC, on the other hand, involves extensive arterial invasion, making curative surgery unfeasible in most cases. The primary goal in LAPC is disease control, with a focus on systemic therapy and, in select cases, conversion to resectability.
A key highlight of this discussion is the role of neoadjuvant therapy. The REDISCOVER 2024 guidelines strongly advocate for a neoadjuvant-first approach in borderline resectable pancreatic cancer. FOLFIRINOX and gemcitabine/nab-paclitaxel are the preferred chemotherapy regimens, depending on patient fitness and comorbidities. Neoadjuvant therapy has been shown to:
Improve R0 resection rates by shrinking tumors and reducing vascular involvement
Eliminate micrometastases before surgery
Allow better selection of patients who will benefit from surgical intervention
For locally advanced pancreatic cancer, induction chemotherapy with FOLFIRINOX or gemcitabine-based regimens remains the cornerstone of treatment. The REDISCOVER 2024 guidelines also emphasize the role of stereotactic body radiation therapy (SBRT) or intensity-modulated radiation therapy (IMRT) in select cases where local tumor control is a priority.
Dr. Desai further discusses surgical considerations in BRPC and LAPC. For patients with good response to neoadjuvant therapy, restaging with contrast-enhanced CT or MRI is crucial to assess tumor resectability. In cases where vascular involvement persists but is limited, vascular resections and reconstructions may be performed to achieve R0 resection. He also highlights the importance of advanced surgical techniques, including arterial divestment and vein grafting, to improve the chances of curative surgery.
In locally advanced disease, conversion surgery remains controversial and is only recommended in highly selected patients who show significant tumor regression after systemic therapy. The REDISCOVER 2024 guidelines suggest that patients with stable or progressive disease after chemotherapy should continue systemic therapy rather than attempt surgical resection.
Dr. Desai also emphasizes the role of novel systemic therapies and targeted treatments based on molecular profiling. The REDISCOVER 2024 guidelines encourage genetic testing for BRCA mutations, KRAS inhibitors, and immunotherapy options, particularly in cases with homologous recombination deficiency or mismatch repair deficiency. Clinical trials are also exploring neoadjuvant immunotherapy combinations to enhance tumor response.
Finally, the discussion highlights the importance of a multidisciplinary approach, including collaboration between pancreatic surgeons, medical oncologists, radiation oncologists, and interventional radiologists, to tailor treatment for each patient. Dr. Desai underscores the need for personalized treatment plans based on tumor biology, response to therapy, and patient factors.
This video provides comprehensive insights into the evolving landscape of pancreatic cancer management, guided by the REDISCOVER 2024 recommendations. Whether you are a surgeon, oncologist, radiologist, or a patient seeking expert knowledge, this discussion will help you understand the latest advancements in treating borderline resectable and locally advanced pancreatic cancer. Be sure to watch until the end for key takeaways and expert recommendations on optimizing patient outcomes.COME JOIN US: OUR DETAILS
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