Management of resectable pancreatic adenocarcinoma continues to present a challenge due to a paucity of high-quality randomized studies. Administration of adjuvant chemotherapy is widely accepted due to the high risk of systemic spread associated with pancreatic adenocarcinoma, but the role of radiation therapy is less clear. This paper reviews literature associated with resectable pancreatic cancer to include prognostic factors to aid in the selection of patients appropriate for adjuvant therapies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
*University of Texas Health Science Center at San Antonio, San Antonio
¶University of Texas MD Anderson Cancer Center, Houston, TX
†Cancer Center of Santa Barbara, Santa Barbara
§§Stanford Cancer Institute, Stanford
¶¶University of California Los Angeles, Los Angeles, CA
‡Cleveland Clinic, Cleveland, OH
***Stritch School of Medicine Loyola University Chicago, Maywood
§Rush University Medical Center, Chicago, IL
∥Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, American Society of Clinical Oncology
†††Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
##Johns Hopkins University, Baltimore, MD, American College of Surgeons
#Henry Ford Hospital, Detroit, MI
**University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO
††Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
‡‡University of Pennsylvania, The Chester County Hospital, West Chester, PA
∥∥Banner MD Anderson Cancer Center, Gilbert, AZ
The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels.
Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document.
This article is a revised version of the American College of Radiology Appropriateness Criteria Resectable Pancreatic Cancer, excerpts of which are reprinted here with permission. Practitioners are encouraged to refer to the complete version at http://www.acr.org/ac.
For additional information on the Appropriateness Criteria methodology and other supporting documents go to http://www.acr.org/ac.
W.S., Jr: has given talks and received an honorarium and travel expenses from the company Zeiss. These talks regard intraoperative radiation. The remaining authors declare no conflicts of interest.
Corresponding Author: William E. Jones III, MD, American College of Radiology, 1891 Preston White Drive, Reston, VA 20191. E-mail: firstname.lastname@example.org.
Reprint requests to: email@example.com.