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Pancreatic borderline

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https://www.readbyqxmd.com/read/28105634/does-radiologic-response-correlate-to-pathologic-response-in-patients-undergoing-neoadjuvant-therapy-for-borderline-resectable-pancreatic-malignancy
#1
Brent T Xia, Baojin Fu, Jiang Wang, Young Kim, S Ameen Ahmad, Vikrom K Dhar, Nick C Levinsky, Dennis J Hanseman, David A Habib, Gregory C Wilson, Milton Smith, Olugbenga O Olowokure, Jordan Kharofa, Ali H Al Humaidi, Kyuran A Choe, Daniel E Abbott, Syed A Ahmad
BACKGROUND AND OBJECTIVES: In patients with borderline resectable pancreas cancers, clinicians frequently consider radiographic response as the primary driver of whether patients should be offered surgical intervention following neoadjuvant therapy (NT). We sought to determine any correlation between radiographic and pathologic response rates following NT. METHODS: Between 2005 and 2015, 38 patients at a tertiary care referral center underwent NT followed by pancreaticoduodenectomy for borderline resectable pancreas cancer...
January 20, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28089484/dosimetric-parameters-correlate-with-duodenal-histopathologic-damage-after-stereotactic-body-radiotherapy-for-pancreatic-cancer-secondary-analysis-of-a-prospective-clinical-trial
#2
Vivek Verma, Audrey J Lazenby, Dandan Zheng, Abhijeet R Bhirud, Quan P Ly, Chandrakanth Are, Aaron R Sasson, Chi Lin
PURPOSE: Prospectively assess relationships between dosimetric parameters and histopathologic/clinical duodenal toxicities in patients on a phase I trial for pancreatic cancer. METHODS: Forty-six borderline resectable/unresectable patients were enrolled on a prospective trial testing neoadjuvant gemcitabine/5-fluorouracil followed by SBRT (5 daily fractions of 5-8Gy) and concurrent nelfinavir. Post-SBRT surgery was performed in 13 resectable patients, which constituted the patient population herein...
January 12, 2017: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
https://www.readbyqxmd.com/read/28089214/prevalence-of-chronic-pancreatitis-results-of-a-primary-care-physician-based-population-study
#3
Gabriele Capurso, Livia Archibugi, Piera Pasquali, Alessandro Aceti, Paolo Balducci, Patrizia Bianchi, Francesco Buono, Stefano Camerucci, Rosanna Cantarini, Sergio Centofanti, Patrizia Colantonio, Riccarda Cremaschi, Sergio Crescenzi, Caterina Di Mauro, Davide Di Renzi, Andrea Filabozzi, Alfonso Fiorillo, Giuseppe Giancaspro, Paola Giovannetti, Giuseppe Lanna, Claudio Medori, Emilio Merletti, Enzo Nunnari, Francesca Paris, Marco Pavone, Angela Piacenti, Almerindo Rossi, Maria Cristina Scamuffa, Giovanni Spinelli, Marco Taborchi, Biagio Valente, Antonella Villanova, Alberto Chiriatti, Gianfranco Delle Fave
BACKGROUND: Data on chronic pancreatitis prevalence are scanty and usually limited to hospital-based studies. AIM: Investigating chronic pancreatitis prevalence in primary care. METHODS: Participating primary care physicians reported the prevalence of chronic pancreatitis among their registered patients, environmental factors and disease characteristics. The data were centrally reviewed and chronic pancreatitis cases defined according to M-ANNHEIM criteria for diagnosis and severity and TIGAR-O classification for etiology...
December 27, 2016: Digestive and Liver Disease
https://www.readbyqxmd.com/read/28078482/irreversible-electroporation-as-treatment-of-locally-advanced-and-as-margin-accentuation-in-borderline-resectable-pancreatic-adenocarcinoma
#4
P Marsanic, A Mellano, A Sottile, M De Simone
In recent years, many local ablation technologies based on thermal damage have been used in the treatment of locally advanced pancreatic carcinoma (LAPC) and borderline resectable pancreatic carcinoma (BLRPC). However, they are associated with major complications because of possible vascular and ductal damage. Irreversible electroporation (IRE) is a nonthermal ablation technology that seems safe near vital vascular and ductal structures. IRE could be used as exclusive treatment of LAPC (en situ to IRE) after induction chemotherapy In BLRPC, surgery is not really radical in 6% of patients (microscopic residual) and local recurrences occur in 11-42% of apparent radical resections...
January 11, 2017: Medical & Biological Engineering & Computing
https://www.readbyqxmd.com/read/28064462/value-of-apparent-diffusion-coefficient-prior-to-neoadjuvant-therapy-is-a-predictor-of-histologic-response-in-patients-with-borderline-resectable-pancreatic-carcinoma
#5
Ken-Ichi Okada, Seiko Hirono, Manabu Kawai, Motoki Miyazawa, Atsushi Shimizu, Yuji Kitahata, Masaki Ueno, Shinya Hayami, Fumiyoshi Kojima, Hiroki Yamaue
BACKGROUND/PURPOSE: The parameters to predict histological response to neoadjuvant therapy remain controversial in borderline resectable pancreatic carcinoma (BRPC). METHODS: Twenty-four patients who underwent diffusion-weighted magnetic resonance imaging (DW-MRI) prior to expected neoadjuvant chemo/chemoradiotherapy and surgery were reviewed retrospectively. Analyses for correlation between percent tumor cell destruction and the following was performed to investigate the parameter and cut off value: tumor size, whole tumor apparent diffusion coefficient (ADC) value of DW-MRI, maximum standardized uptake value of (18) F-fluorodeoxyglucose positron emission tomography, carbohydrate antigen 19-9, and their change ratios...
January 8, 2017: Journal of Hepato-biliary-pancreatic Sciences
https://www.readbyqxmd.com/read/28057010/update-on-lysinuric-protein-intolerance-a-multi-faceted-disease-retrospective-cohort-analysis-from-birth-to-adulthood
#6
Wladimir Mauhin, Florence Habarou, Stéphanie Gobin, Aude Servais, Anaïs Brassier, Coraline Grisel, Célina Roda, Graziella Pinto, Despina Moshous, Fahd Ghalim, Pauline Krug, Nelly Deltour, Clément Pontoizeau, Sandrine Dubois, Murielle Assoun, Louise Galmiche, Jean-Paul Bonnefont, Chris Ottolenghi, Jacques de Blic, Jean-Baptiste Arnoux, Pascale de Lonlay
BACKGROUND: Lysinuric protein intolerance (LPI) is a rare metabolic disease resulting from recessive-inherited mutations in the SLC7A7 gene encoding the cationic amino-acids transporter subunit y(+)LAT1. The disease is characterised by protein-rich food intolerance with secondary urea cycle disorder, but symptoms are heterogeneous ranging from infiltrative lung disease, kidney failure to auto-immune complications. This retrospective study of all cases treated at Necker Hospital (Paris, France) since 1977 describes LPI in both children and adults in order to improve therapeutic management...
January 5, 2017: Orphanet Journal of Rare Diseases
https://www.readbyqxmd.com/read/28056259/-progress-in-neoadjuvant-and-transformation-therapy-of-pancreatic-cancer
#7
D D Hu, M H Dai
Pancreatic adenocarcinoma is a malignant disease with considerable metastatic potential.While surgical resection can be potentially curative, tumor recurrence remains an important cause of treatment failure.Neoadjuvant chemotherapy can increase rate of resectability by decreasing tumor burden and decrease recurrence rate by clearing microscopic disease in lymph nodes and vessels.Currently, neoadjuvant therapy is recommended for patients with resectable who has signs of high risks or borderline resectable pancreatic adenocarcinoma...
January 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/28054192/five-year-actual-overall-survival-in-resected-pancreatic-cancer-a-contemporary-single-institution-experience-from-a-multidisciplinary-perspective
#8
Vincent J Picozzi, Stephen Y Oh, Alicia Edwards, Margaret T Mandelson, Russell Dorer, Flavio G Rocha, Adnan Alseidi, Thomas Biehl, L William Traverso, William S Helton, Richard A Kozarek
BACKGROUND: Successful surgical resection combined with effective perioperative therapy is essential for maximizing long-term survival for pancreatic adenocarcinoma. PATIENTS AND METHODS: All patients with pancreatic adenocarcinoma who underwent curative resection at our institution from January 2003 to May 2010 were reviewed. Demographic and clinical details were retrospectively collected from medical records and cancer registry data. RESULTS: Overall, 176 patients were included in the analysis (148 with de novo resectable disease and 28 with borderline resectable disease at presentation)...
January 4, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28050151/eastern-canadian-gastrointestinal-cancer-consensus-conference-2016
#9
D Bossé, T Ng, C Ahmad, A Alfakeeh, I Alruzug, J Biagi, J Brierley, P Chaudhury, S Cleary, B Colwell, C Cripps, L A Dawson, M Dorreen, E Ferland, P Galiatsatos, S Girard, S Gray, F Halwani, N Kopek, A Mahmud, G Martel, L Robillard, B Samson, M Seal, J Siddiqui, L Sideris, S Snow, M Thirwell, M Vickers, R Goodwin, R Goel, T Hsu, E Tsvetkova, B Ward, T Asmis
The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference 2016 was held in Montreal, Quebec, 5-7 February. Experts in radiation oncology, medical oncology, surgical oncology, and infectious diseases involved in the management of patients with gastrointestinal malignancies participated in presentations and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses multiple topics: ■ Follow-up and survivorship of patients with resected colorectal cancer■ Indications for liver metastasectomy■ Treatment of oligometastases by stereotactic body radiation therapy■ Treatment of borderline resectable and unresectable pancreatic cancer■ Transarterial chemoembolization in hepatocellular carcinoma■ Infectious complications of antineoplastic agents...
December 2016: Current Oncology
https://www.readbyqxmd.com/read/28048258/su-f-r-47-quantitative-shape-relationship-analysis-of-ptv-modification-for-critical-anatomy-sparing-and-its-impact-on-pathologic-response-for-neoadjuvant-stereotactic-radiotherapy-for-pancreatic-cancer
#10
Z Cheng, L Rosati, L Chen, S Robertson, J Moore, L Peng, O Mian, A Narang, A Hacker-Prietz, J Herman, T McNutt
PURPOSE: Stereotactic body radiation therapy (SBRT) may be used to increase surgery candidacy in borderline resectable (BRPC) and locally advanced (LAPC) pancreatic cancer. However, the planning target volume (PTV) may need to be limited to avoid toxicity when the gross tumor volume (GTV) is anatomically involved with surrounding critical structures. Our study aims to characterize the coverage of GTV and investigate the association between modified PTV and pathologic (pCR) or near pathologic (npCR) complete response rates determined from the surgical specimen...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28046466/su-f-t-395-evaluation-of-best-dosimetry-achievable-with-vmat-and-imrt-treatment-techniques-targeting-borderline-resectable-pancreatic-cancer
#11
K Harpool, E Schnell, T Herman, S Ahmad, T De La Fuente Herman
PURPOSE: To determine from retrospective study the most appropriate technique for targeting small borderline operable pancreatic cancer surrounding blood vessels by evaluating the dosimetry and normal tissue sparing achievable using Volumetric Modulated Arc Therapy (VMAT) and Intensity Modulated Radiation Therapy (IMRT). METHODS: Treatment plans from ten patients who have undergone treatment with a prescribed dose of 4950 cGy, at 275 cGy per fraction, were analyzed...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28043760/endoscopic-ultrasonography-complements-computed-tomography-in-predicting-portal-or-superior-mesenteric-vein-resection-in-patients-with-borderline-resectable-pancreatic-carcinoma
#12
Evan S Glazer, Omar M Rashid, Jason B Klapman, Cynthia L Harris, Pamela J Hodul, Jose M Pimiento, Mokenge P Malafa
BACKGROUND: Current guidelines recommend computed tomographic (CT) scans for vascular staging of patients with pancreatic carcinoma; however, endoscopic ultrasonography (EUS) in these patients is not required and its utility in combination with CT scan is less well-defined. The purpose of this study is to explore the utility of EUS in addition to CT in identifying patients with borderline resectable pancreatic carcinoma (BRPC). METHODS: We reviewed our database of patients with BRPC who went to surgery with curative intent...
December 5, 2016: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
https://www.readbyqxmd.com/read/27938571/-surgical-treatment-of-pancreatic-carcinoma-problems-and-recent-advances
#13
Y M Yang, Y P Zhao
Nowadays surgical technologies develop fast under the guidance of minimally invasive medicine, evidence-based medicine, multi-disciplinary team and other ideas. However, the long-term outcome of pancreatic cancer remains dismal. In addition to the improvement of surgical resection rate, more attention should be paid to improve the overall survival rate of the patients with pancreatic cancer after surgery. Clinical studies of neoadjuvant therapies for the treatment of borderline resectable pancreatic cancer are advocated...
1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/27935952/neoadjuvant-gemcitabine-chemotherapy-followed-by-concurrent-imrt-simultaneous-boost-achieves-high-r0-resection-in-borderline-resectable-pancreatic-cancer-patients
#14
Xiaolun Huang, Jeanna L Knoble, Ming Zeng, Fernando N Aguila, Tara Patel, Lowell W Chambers, Honglin Hu, Hao Liu
BACKGROUND: To study the feasibility of down stage the borderline resectable pancreatic cancer (BRPC) to resectable disease, we reported our institutional results using an intensity-modulated radiation therapy (IMRT) simultaneous integrated boost (SIB) dose escalation approach to improve R0 resectability. METHODS: We reviewed our past 7 years of experience of using neoadjuvant induction chemotherapy with Gemcitabine followed by concurrent chemoradiaiton for BRPC...
2016: PloS One
https://www.readbyqxmd.com/read/27931968/borderline-resectable-pancreatic-cancer-more-than-an-anatomical-concept
#15
Fausto Petrelli, Alessandro Inno, Sandro Barni, Antonio Ghidini, Roberto Labianca, Massimo Falconi, Michele Reni, Stefano Cascinu
Borderline resectable pancreatic cancer (BRPC) accounts for about 10-15% of newly diagnosed pancreatic cancer, and its management requires a skilled multidisciplinary team. The main definition of BRPC refers to resectability, but also a high risk of positive surgical margins and recurrence. This raises questions about the value of surgery and suggests an opportunity to utilize preoperative treatment in this subset of patients. Besides technical borderline resectable disease which is defined on anatomical and radiological criteria, there is also a biological borderline resectable disease which is defined on clinical and biological prognostic factors...
December 5, 2016: Digestive and Liver Disease
https://www.readbyqxmd.com/read/27896658/poor-glycemic-control-is-associated-with-failure-to-complete-neoadjuvant-therapy-and-surgery-in-patients-with-localized-pancreatic-cancer
#16
E S Paul Rajamanickam, K K Christians, M Aldakkak, A N Krepline, P S Ritch, B George, B A Erickson, W D Foley, M Aburajab, D B Evans, S Tsai
BACKGROUND: The impact of glycemic control in patients with pancreatic cancer treated with neoadjuvant therapy is unclear. METHODS: Glycated hemoglobin (HbA1c) values were measured in patients with localized pancreatic cancer prior to any therapy (pretreatment) and after neoadjuvant therapy prior to surgery (preoperative). HbA1c levels greater than 6.5% were classified as abnormal. Patients were categorized based on the change in HbA1c levels from pretreatment to preoperative: GrpA, always normal; Gr B, worsened; GrpC, improved; and GrpD, always abnormal...
November 28, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/27896637/seom-clinical-guideline-for-the-treatment-of-pancreatic-cancer-2016
#17
R Vera, E Dotor, J Feliu, E González, B Laquente, T Macarulla, E Martínez, J Maurel, M Salgado, J L Manzano
Pancreatic cancer remains an aggressive disease with a 5 year survival rate of 5%. Only 15% of patients with pancreatic cancer are eligible for radical surgery. Evidence suggests a benefit on survival with adjuvant chemotherapy (gemcitabine o fluourouracil) after R1/R0 resection. Adjuvant chemoradiotherapy is also a valid option in patients with positive margins. Borderline resectable pancreatic cancer is defined as the involvement of the mesenteric vasculature with a limited extension. These tumors are technically resectable, but with a high risk of positive margins...
December 2016: Clinical & Translational Oncology
https://www.readbyqxmd.com/read/27896469/ct-evaluation-after-neoadjuvant-folfirinox-chemotherapy-for-borderline-and-locally-advanced-pancreatic-adenocarcinoma
#18
Mathilde Wagner, Celia Antunes, Daniel Pietrasz, Christophe Cassinotto, Magaly Zappa, Antonio Sa Cunha, Oliver Lucidarme, Jean-Baptiste Bachet
AIM: To assess anatomic changes on computed tomography (CT) after neoadjuvant FOLFIRINOX (5-fluorouracil/leucovorin/irinotecan/oxaliplatin) chemotherapy for secondary resected borderline resectable (BR) and locally advanced (LA) pancreatic adenocarcinoma and their accuracy to predict resectability and pathological response. METHODS: Thirty-six patients with secondary resected BR/LA pancreatic adenocarcinoma after neoadjuvant FOLFIRINOX chemotherapy (± chemoradiotherapy) were retrospectively included...
November 28, 2016: European Radiology
https://www.readbyqxmd.com/read/27885893/tumor-vessel-relationships-in-pancreatic-ductal-adenocarcinoma-at-multidetector-ct-different-classification-systems-and-their-influence-on-treatment-planning
#19
Ahmed M Zaky, Christopher L Wolfgang, Matthew J Weiss, Ammar A Javed, Elliot K Fishman, Atif Zaheer
Treatment of pancreatic ductal adenocarcinoma (PDAC) remains a challenge, given its propensity for early systemic spread and growth into the adjacent vital vascular structures. With the advent of newer surgical techniques and chemoradiation therapies, multidetector computed tomography (CT) plays a crucial role in the identification of patients with borderline resectable disease who may benefit from such treatments. Stage III PDAC is divided into two categories-locally advanced, defined by arterial encasement or nonreconstructible portovenous axis involvement; and borderline resectable, defined by limited arterial involvement and/or reconstructible portovenous involvement...
January 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/27885876/predictors-and-survival-for-pathologic-tumor-response-grade-in-borderline-resectable-and-locally-advanced-pancreatic-cancer-treated-with-induction-chemotherapy-and-neoadjuvant-stereotactic-body-radiotherapy
#20
Eric A Mellon, William H Jin, Jessica M Frakes, Barbara A Centeno, Tobin J Strom, Gregory M Springett, Mokenge P Malafa, Ravi Shridhar, Pamela J Hodul, Sarah E Hoffe
BACKGROUND: Neoadjuvant therapy response correlates with survival in multiple gastrointestinal malignancies. To potentially augment neoadjuvant response for pancreas adenocarcinoma, we intensified treatment with stereotactic body radiotherapy (SBRT) following multi-agent chemotherapy. Using this regimen, we analyzed whether the College of American Pathology (CAP) tumor regression grade (TRG) at pancreatectomy correlated with established response biomarkers and survival. MATERIALS AND METHODS: We identified borderline resectable (BRPC) and locally advanced (LAPC) pancreatic cancer patients treated according to our institutional clinical pathway who underwent surgical resection with reported TRG (n = 81, median follow-up after surgery 24...
November 25, 2016: Acta Oncologica
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