NCCN Guidelines for Patients® | Pancreatic Cancer - page 61

NCCN Guidelines for Patients
Pancreatic Cancer, Version 1.2014
Treatment guide
Borderline resectable pancreatic cancer
If the tests don’t show any signs of recurrence
or metastases,
the next treatment recommendations
depend on whether or not you had neoadjuvant
treatment before surgery.
If you had neoadjuvant
then your doctor may want to give you
more chemotherapy as adjuvant treatment. However,
doctors don’t often give both neoadjuvant and
adjuvant treatment for pancreatic cancer.
If you did not have neoadjuvant treatment before
then you have 3 options to choose from for
adjuvant treatment. Adjuvant treatment should only
be started after you’ve fully recovered from surgery.
Starting 4 to 8 weeks after surgery is ideal.
Adjuvant treatment
There are three main adjuvant treatment options to
choose from. Taking part in a clinical trial
is strongly
recommended and is the preferred option for adjuvant
treatment. A clinical trial is a type of research that
studies the safety and effectiveness of a test or
treatment. Read Part 3 on page 30 for more details
on clinical trials.
If you aren’t able to join a clinical trial,
another option
is to receive chemotherapy and chemoradiation.
In this case, chemotherapy may be given before
or after chemoradiation. Another CT scan is
recommended after chemotherapy if it will be followed
by chemoradiation. Recommended chemotherapy
drugs include gemcitabine, 5-FU with leucovorin, or
continuous infusion 5-FU. Chemoradiation may be
fluoropyrimidine-based or gemcitabine-based. Read
Part 3 on page 24 for details on each treatment.
The third option is to receive chemotherapy only.
In this case, chemotherapy drug options include
gemcitabine, 5-FU with leucovorin, continuous
infusion 5-FU, or capecitabine. Gemcitabine is
preferred because its side effects aren’t as severe as
5-FU/leucovorin. Capecitabine is suggested as a last
choice only when other options cannot be used.
After completing adjuvant treatment, you will have
follow-up tests. Follow-up tests are tests given after
treatment to check how well treatment worked. These
tests look for signs of cancer return (recurrence) or
spread (metastasis) after treatment.
Follow-up tests are recommended every 3 to 6
months for 2 years, and then once every year. A
medical history and physical exam can help to find
signs and symptoms of pancreatic cancer early. CA
19-9 is a substance found in blood and high levels
can be caused by pancreatic cancer. Thus, a CA
19-9 blood test is recommended as part of follow-
up testing. A CT scan is also recommended to look
for early signs of cancer recurrence. Read Part 2 on
page 14 for test details.
Next steps:
After completing adjuvant treatment,
if follow-up tests show a recurrence,
see Chart 5.3.5 for treatment
recommendations. If tests after surgery
found metastases, see Part 5.5 for
treatment recommendations.
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