The Clinical Borderline Resectable Classification (CBRC) System for pancreatic cancer has been described at the MD Anderson Cancer Center (MDACC). This can help to guide the multi-disciplinary management of challenging pancreatic cancers.
Patient selection: pancreatic carcinoma
Types:
(1) Type A: borderline resectable tumor based on anatomy as defined on CT images (see below)
(2) Type B: resectable or borderline resectable AND possible extrapancreatic metastatic disease including N1 disease
(3) Type C: resectable or borderline resectable AND one or both of the following -
(3a) marginal performance status (Zubrod 3), potentially reversible
(3b) severe pre-existing medical comorbidity, potentially reversible or controllable
If more than 1 type is present, then priority is given to C, then B.
Borderline resectability on CT images:
(1) tumor abuts the superior mesenteric artery or celiac axis, involving <= 180° of circumference
(2) tumor abuts (<= 180°) or encases (>180°) a short segment of the hepatic artery
(3) short segment tumor occlusion of the superior mesenteric and/or portal vein that is amenable to resection and reconstruction
