Introduction: The Challenge of Conversion in Pancreatic Cancer
The management of borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) remains one of the most formidable challenges in surgical oncology. While radical surgical resection offers the only potential for long-term survival, the majority of patients present with tumors that involve critical peripancreatic vasculature, precluding immediate surgery. Historically, neoadjuvant or conversion therapy using multi-agent chemotherapy, such as FOLFIRINOX or albumin-bound (nab)-paclitaxel plus gemcitabine (AG), has been the standard of care. However, R0 resection rates and overall survival remain suboptimal. In recent years, the integration of immune checkpoint inhibitors and radiotherapy has emerged as a promising strategy to enhance local control and systemic efficacy. The THAG trial—evaluating tislelizumab, hypofractionated radiotherapy, and AG—represents a significant step forward in optimizing conversion therapy for this high-risk population.
