Pancreatic head mass: how can we treat it? Tumor: conservative treatment.

A few years ago the current opinion on pancreatic cancer (PC) was that the only curative option was surgical resection, since this neoplasm is chemoand radio-resistant. Only about 20% of diagnosed tumors were resectable with 10% confined to the pancreas. Forty percent were locally advanced (T3 N0 M0, T1-3 N1 M0; stage III-UICC) and 50% were metastatic (any T-N, M1; stage IVUICC) [1-6] and the majority was unresponsive to chemoand/or radio-therapy with many toxic side effects. Nowadays the 5-year survival is still poor, but a multimodal therapeutic approach extends the life span and improves thequality of life. A multimodal therapy includes two or more of following therapeutic approaches: chemoor chemoradio-therapy, adjuvant therapy, neoadjuvant therapy, endoscopic therapy and the newer therapeutic frontiers of immunotherapy, angiogenesis-inhibitors and gene-therapy.