Introduction

Pancreatic cancer is still a disease with an extremely low 5 years survival of 10-20%. Surgical resection is the only potentially curative treatment, but involves a demanding peri-operative treatment regimen of extensive abdominal surgery in combination with systemic (radio)chemotherapy. For primary resectable tumors surgical resection remains the first choice, supplemented with adjuvant chemotherapy. In case of borderline (BR) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC), neoadjuvant therapy is nowadays administered as part of a multimodal treatment to achieve higher surgical resectability and improve survival. Resection rates and patient survival vary in the literature according to patient selection. However, even after completion of the treatment local and systemic recurrence of the disease is frequently observed and overall benefits for these patients considering morbidity and survival is sometimes questionnable.

Methodology

Currently a multicentric prospective cohort trial is conducted and ongoing with the collaboration of all our referral centers within the pancreatic surgery convention in Belgium. Patients with BR and LA PADC will be included and undergo neoadjuvant chemotherapy with FOLFIRINOX. The primary endpoint of the trial is the accuracy of prediction of surgical resection after neo-adjuvant chemotherapy. Secondary endpoints are overall survival and disease-free survival from the date of diagnosis, R0 and R1 resection rates, histopathological response, postoperative complication rates, patient reported outcomes with quality of life and health economic analysis. Translational research with multi-omics and radiomics based on computed tomography and magnetic resonance imaging will try to identify factors predictive of surgical resectabilty and survival. Quality of life will be evaluated using a specific pancreas questionnaire, the EORTC QLQ - PAN26 at different time points during the treatment period and therafter, and a comparitive analysis will be performed between this study cohort versus primary resectable patients.

Discussion

Improved parameters are necessary in BR and LA PDAC for a correct prognostication of the disease. The role of a combination of clinical, radiological, and multi-omics profiling in liquid biopsies will be investigated, whether they can predict successful surgical resection and optimize the therapeutic decision tree. Furthermore, we want to evaluate patient related outcome measures and quality of life throughout the treatment period to evaluate the real benefit of surgical treatment in combination with systemic therapy for these advanced pancreatic cancer patients as well as in comparison with primary resectable patients.