Implementation of a standardized approach to borderline resectable pancreatic cancer in a community oncology program.

493Background: Treatment paradigms for borderline resectable pancreatic cancer (BRPC) continue to evolve with increasing use of neoadjuvant chemotherapy (NAC) and chemoradiation (NACR). Variations in the definition of BRPC and in neoadjuvant approaches have made standardization of care for BRPC difficult. We report an effort to standardize management of BRPC throughout Sanford Health, a largely rural community oncology (CO) network in the Upper Midwest. Methods: Starting in February 2014, cases of PC without evidence of metastatic disease were categorized as BRPC if they met one or more of the following criteria: 1) abutment of superior mesenteric, common hepatic or celiac arteries with < 180o involvement 2) venous involvement deemed potentially reconstructable and/or 3) biopsy proven regional lymph node involvement. Patients with BRPC were treated with NAC followed by reimaging and surgery if resectable; if disease remained BRPC, patients underwent NACR and surgical re-evaluation. NAC was administered at...