Welcome back to Rad Onc Smart Review, GI Series. In our last episode, we wrestled with the difficult data for adjuvant therapy, where even after a grueling Whipple procedure, the prognosis remains guarded. This reality has fueled one of the most significant paradigm shifts in modern GI oncology: moving therapy from the postoperative to the preoperative setting. The rationale is simple yet powerful: select the right patients, improve the quality of surgery, and deliver systemic therapy when patients are strongest. Today, we explore this neoadjuvant revolution. We’ll start by defining who is and who is not a surgical candidate based on the critical vascular anatomy. Then, we’ll dive into the landmark trials—PREOPANC-1 and Alliance A-0-2-1-5-0-1—that are shaping our current standards and fueling the ongoing debate.

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