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NCCN Guidelines for Patients



Pancreatic Cancer, Version 1.2017


Treatment guide Locally advanced unresectable pancreatic cancer

Guide 14

shows the first-line treatment

recommendations for locally advanced unresectable

pancreatic cancer. First-line treatment is the first

treatment or set of treatments given to control the

cancer. First-line treatment options include a clinical

trial, chemotherapy, chemoradiation, and supportive


Performance status rating

Which treatment is recommended for you depends

on your health status rating, also called performance

status. Your performance status is a rating by

your doctor based on your overall health, cancer

symptoms, and ability to do daily activities.

Good performance status means that your overall

health is good and you’re able to continue doing all

of your regular daily activities very well. You also

have very few or very mild symptoms of the cancer

and you’re able to eat well. Poor performance status

means that your overall health is poor. You aren’t

able to do your regular daily activities well, and you

are suffering from a number of cancer symptoms.

Your performance status rating is a very important

factor when choosing the best treatment for you. This

is because patients with a better performance status

are able to tolerate treatments with higher risks of

side effects. Your doctor should explain all of the

risks and possible side effects of the treatments you


Guide 14. First-line treatment

Performance status rating First-line treatment

Good performance status


• Clinical trial (preferred)


• Chemotherapy


• Chemotherapy, followed by

chemoradiation or SBRT

(patients with locally advanced

disease only)


• Chemoradiation or SBRT

for patients who cannot get

combination chemotherapy


• For good

performance status

and disease



Guide 15

Poor performance status


• Chemotherapy (one drug)


• Radiation for palliative care


• Other palliative and best supportive care