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Using drugs, radiotherapy or embolisation to shrink a cancer from a stage where curative treatment is impossible to one where it is: for example, shrinking liver metastases until they can be cut out, or liver cancer until it fits transplant criteria.
Downstaging is central to liver transplantation for hepatocellular carcinoma (patients beyond Milan criteria who respond to TACE or radioembolisation and stay within criteria for 3-6 months achieve post-transplant survival similar to those within criteria from the start, UNOS-DS) and to colorectal liver metastases, where 15-30% of initially unresectable patients become resectable after FOLFOXIRI or doublet plus antibody ('conversion therapy'). Neoadjuvant therapy that converts mastectomy to lumpectomy, or borderline to resectable pancreatic cancer, follows the same logic. Pathological downstaging (ypT/ypN lower than clinical stage) after neoadjuvant therapy is itself a favourable prognostic sign.
Shares Vascular resection in pancreatic cancer surgery (portal and superior mesenteric vein resection; arterial resection), Neoadjuvant therapy versus surgery first for resectable and borderline resectable pancreatic cancer, Resectable, borderline resectable and unresectable, Pancreatic ductal adenocarcinoma.
Shares BCLC staging, Transarterial chemoembolisation (TACE), Hepatocellular carcinoma.
Shares Vascular resection in pancreatic cancer surgery (portal and superior mesenteric vein resection; arterial resection), Neoadjuvant therapy versus surgery first for resectable and borderline resectable pancreatic cancer, Pancreatic ductal adenocarcinoma.
Shares BCLC staging, Transarterial chemoembolisation (TACE), Hepatocellular carcinoma.
Shares BCLC staging, Hepatectomy (liver resection), Hepatocellular carcinoma.
Shares BCLC staging, Hepatocellular carcinoma.
Shares Resectable, borderline resectable and unresectable, Neoadjuvant / adjuvant / perioperative, Pancreatic ductal adenocarcinoma.
Shares Transarterial chemoembolisation (TACE), Hepatocellular carcinoma.