Current practices and challenges in the management of nonmetastatic pancreatic adenocarcinoma: results of an EORTC survey.

Background: The optimal therapeutic strategy for nonmetastatic pancreatic ductal adenocarcinoma (PDAC) remains controversial. This study sought to provide an overview of contemporary clinical management patterns across Europe. Materials and methods: A survey was designed by a multidisciplinary team under the aegis of the European Organization of Research and Treatment of Cancer Gastrointestinal Tract Cancer Group, providing insights into initial diagnosis, surgery, and clinical management of patients with resectable, borderline resectable (BR), and locally advanced (LA) PDAC. Results: Eighty-three practitioners from 16 European countries answered the survey. In cases of resectable PDAC, frontline surgery was the preferred option (74%) followed by neoadjuvant chemotherapy (22%). For BR PDAC, the preferred induction strategy was chemotherapy alone (70%). Radiotherapy (RT) was proposed to be added after chemotherapy in cases of poor response or persistence of vascular contact (37%). For LA PDAC, the panel's strategies were (i) induction chemotherapy followed by chemoradiotherapy (42%), (ii) chemotherapy alone (35%), and (iii) chemotherapy followed by stereotactic body radiotherapy (23%). In cases of very good response without remaining vascular contact or with a carbohydrate antigen 19-9 (CA19-9) normalization after induction chemotherapy, cancellation of the planned RT, leading to immediate surgical exploration, was proposed in 77% and 42%, respectively. Conclusion: This European survey highlights the significant heterogeneity in PDAC clinical practices and the frequent reconsideration and adaptation of the initially planned therapeutic strategies according to treatment response, a question not explored in clinical trials. This study demonstrates the urgent need to harmonize practices in Europe.