Table 1.

Clinical presentation: resectable.

Guideline/Year	International/National (State)	Main Option	Alternative
NCCN 2020 [3]	International	➢Surgery + Adjuvant Therapy •“Adjuvant Therapy“ includes ○Clinical Trial (preferred option); ○CT Alone; ○CT → RTCT ± CT •Preferred CT Regimens: FOLFIRINOX or mFOLFIRINOX;	•Alternative Adjuvant CT Regimens: Gemcitabine + albumin-bound paclitaxel •Neoadjuvant Therapy for High Risk (includes imaging findings, very highly elevated CA 19-9, large primary tumors, large regional lymph nodes, excessive weight loss, and extreme pain)
ESMO 2015 [21,41]	International	➢Surgery + Adjuvant CT •CT Regimens: i) gemcitabine or ii) 5-FU folinic acid •Note: No RTCT should be given except in clinical trials	-
PDQ® 2020 [32]	International	➢Surgery + Adjuvant CT (6 mos) •Preferred CT Regimens: FOLFIRINOX	•Alternative Adjuvant CT Regimens: “Gemcitabine” •Alternative Adjuvant CT Regimens: “5Fu” •Alternative Adjuvant CT Regimens: “S1 in Asia” •Surgery + Adjuvant CT ± RTCT (“controversial”) •Neoadjuvant CT ± RT (“under evaluation”)
ASCO Khoarana 2019 [29]	International	➢Surgery (“recommended”) + 6-mth adjuvant CT (for: good PS; non extrapancreatic disease; no radiographic interface between primary tumor and mesenteric vasculature; Ca19.9 suggestive of potentially curable disease) •Preferred Adjuvant CT Regimens: mFOLFIRINOX ➢6 mos of Neoadjuvant Therapy + Surgery (selected cases)	•Alternative Adjuvant CT Regimens: doublet therapy with gemcitabine and capecitabine or monotherapy with gemcitabine alone or fluorouracil plus folinic acid alone •Adjuvant RTCT after 4–6 mos of adjuvant CT (for R1 and/or N+ patients who have not received Neoadjuvant Therapy •Neoadjuvant Therapy (for good PS; non extrapancreatic disease; no radiographic interface between primary tumor and mesenteric vasculature; and Ca19.9 suggestive of potentially curable disease)
ASTRO 2019 [31]	International	➢Adjuvant CT alone following R0 resection for pN0 ➢Adjuvant RTCT following R0 resection for pN+ should be discussed	•Surgery + Adjuvant RTCT for high-risk (R1-R2; pN+) patients is conditionally recommended (4–6 mos after CT) •Surgery + Adjuvant SBRT: only in clinical Trials •Neoadjuvant therapy is conditionally recommended
Hidalgo 2017 [33]	National (Spain)	➢Surgery + Adjuvant CT (for patients R0/R1; PT1-4/N0-1M0; ECOG PS 0–1; and proper nutritional status)	•“Adjuvant RT” (for R+ and/or N+ patients who did not received preoperatively) •Neoadjuvant Therapy only in Clinical Trials
Neuzillet 2018 [34]	National (French)	➢Surgery + Adjuvant CT (6 mos; “for all patients”) •Preferred Adjuvant CT Regimens: mFOLFIRINOX	•Alternative Adjuvant CT Regimens: Gemcitabine •Alternative Adjuvant CT Regimens: 5-Fu •Alternative Adjuvant CT Regimens: Gemcitabine+Capecitabine •Adjuvant RTCT is not recommended even in the case of R1 resection (only clinical trials) •Neoadjuvant therapy in Clinical trials
O’Reilly 2018 [35]	National (UK)	➢Surgery + Adjuvant CT •Preferred Adjuvant CT Regimens: gemcitabine plus capecitabine	•Alternative Adjuvant CT Regimens: Gemcitabine •Unable to make recommendations about adjuvant RTCT •Neoadjuvant therapy only in clinical trials
Seufferlein 2014 - (S3 Guideline) [36]	National (German)	➢Surgery + Adjuvant CT (6 mos; also for R0/R1 resection) •Preferred Adjuvant CT Regimens: gemcitabine or 5-fluorouracil (5-FU)	•Adjuvant RTCT only in randomized controlled trials •“Neoadjuvant RT, RTCT or CT only in randomized controlled trials
Yamaguchi 2017 [37]	National (Japan)	➢Surgery + Adjuvant CT •Preferred Adjuvant CT Regimens: “S-1 monotherapy”	•Alternative Adjuvant CT Regimens: gemcitabine hydrochloride monotherapy •Adjuvant RTCT is not recommended •IORT is not recommended •Neoadjuvant therapy (“CT or RTCT”) only in clinical trials
AIOM 2019 [39]	National (Italian)	➢Surgery + Adjuvant CT; (also for R0/R1 resection) •Preferred Adjuvant CT Regimens: “FOLFIRINOX”	•Alternative Adjuvant CT Regimens: “Gemcitabine+Capecitabine”; for R0/R1 resection •Alternative Adjuvant CT Regimens: “Gemcitabine” for 6 mos; for R0/R1 resection •Alternative Adjuvant CT Regimens: “5FU/Leucovorin” for 6 mos; for R0/R1 resection •Surgery + Adjuvant CT (“Capecitabine” for 6 mos → RTCT; for selected patients) •Neoadjuvant CT→Surgery →Postoperative CT (3+3 mos)
Hyde 2019 [38]	National (Eastern Canada) Consensus Conference	➢Surgery + Adjuvant CT (6 mos; “for all stages”) •Preferred Adjuvant CT Regimens: “mFOLFIRINOX”	•Alternative Adjuvant CT Regimens: “Gemcitabine-Capecitabine” (6 mos; “for all stages”) •Alternative Adjuvant CT Regimens: “Gemcitabine” (6 mos; “for all stages”) •Neoadjuvant CT (under investigation; to be considered) •Neoadjuvant RT (under investigation; to be considered) •“Superiority of preoperative RTCT over preoperative CT has not been unequivocally demonstrated” •“RT could be considered in high-risk disease”

Legend: CT: Chemotherapy; RTCT: Radiochemotherapy; RT: Radiotherapy; SBRT: sterotactic RT; IORT: Intraoperative RT; BRT: Brachitherapy; GTV: Gross Tumor Volume; CTV: Clinical Target Volume; GEM: Gemcitabine; 5-Fu: 5_Fluoruracil; Lnf: lymph-nodes; mo: months; R0: Microsopically negative resection; R1: Microsopically positive resection; pN+: pathologically positive nodal status; M0: absence of distant metastases; ➢ Primary indication; • Details reported; ○ Alternatives (if present) for the same priority level/detail indicated.