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Pancreatic borderline

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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
#1
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
#2
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
#3
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
#4
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...
November 25, 2016: 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
#5
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
https://www.readbyqxmd.com/read/27882472/the-role-of-venous-and-arterial-resection-in-pancreatic-cancer-surgery
#6
Gyulnara G Kasumova, W Charles Conway, Jennifer F Tseng
Pancreatic cancer continues to carry a dismal prognosis with the majority of patients presenting at advanced stages of disease. Complete surgical resection remains essential for prolonging survival and increasing the possibility of cure. However, few patients will be resectable at diagnosis, with a significant portion presenting with borderline or locally advanced disease. The addition of vascular resection and reconstruction at the time of pancreatectomy enables expansion of the patient population able to undergo resection with curative intent and achieve tumor-free margins...
November 23, 2016: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/27878355/survival-impact-of-neoadjuvant-gemcitabine-plus-s-1-chemotherapy-for-patients-with-borderline-resectable-pancreatic-carcinoma-with-arterial-contact
#7
Yoshiaki Murakami, Kenichiro Uemura, Takeshi Sudo, Yasushi Hashimoto, Naru Kondo, Naoya Nakagawa, Shinya Takahashi, Taijiro Sueda
PURPOSE: The aim of this study was to evaluate the efficacy of neoadjuvant gemcitabine plus S-1 (GS) chemotherapy as measured by overall survival for patients with pancreatic carcinoma with arterial contact. METHODS: Medical records of 77 patients with pancreatic carcinoma with arterial contact who intended to undergo tumor resection were analyzed retrospectively. These patients were divided into two groups: patients who underwent upfront surgery and patients who underwent tumor resection after neoadjuvant GS chemotherapy...
November 22, 2016: Cancer Chemotherapy and Pharmacology
https://www.readbyqxmd.com/read/27865282/techniques-of-vascular-resection-and-reconstruction-in-pancreatic-cancer
#8
REVIEW
George Younan, Susan Tsai, Douglas B Evans, Kathleen K Christians
Multimodality therapy has become the standard approach for the treatment of pancreatic cancer. With improved response rates to newer chemotherapeutic agents, tumors that used to be considered unresectable are now being considered for operation. Neoadjuvant therapy for borderline resectable pancreatic cancer is considered standard of care and venous resection/reconstruction is no longer controversial. Arterial resection and reconstruction in select patients has also proven to be safe when done in highly specialized centers by high-volume surgeons...
December 2016: Surgical Clinics of North America
https://www.readbyqxmd.com/read/27865281/definition-and-management-of-borderline-resectable-pancreatic-cancer
#9
REVIEW
Jason W Denbo, Jason B Fleming
Patients with localized pancreatic ductal adenocarcinoma seek potentially curative treatment, but this group represents a spectrum of disease. Patients with borderline resectable primary tumors are a unique subset whose successful therapy requires a care team with expertise in medical care, imaging, surgery, medical oncology, and radiation oncology. This team must identify patients with borderline tumors then carefully prescribe and execute a combined treatment strategy with the highest possibility of cure...
December 2016: Surgical Clinics of North America
https://www.readbyqxmd.com/read/27864998/rnf43-mutation-frequently-occurs-with-gnas-mutation-and-mucin-hypersecretion-in-intraductal-papillary-neoplasms-of-the-bile-duct
#10
Jia-Huei Tsai, Jau-Yu Liau, Chang-Tsu Yuan, Mei-Ling Cheng, Ray-Hwang Yuan, Yung-Ming Jeng
RNF43 is a tumor suppressor gene that is frequently mutated in intraductal papillary mucinous neoplasms of the pancreas (IPMN). RNF43 suppresses the Wnt/β-catenin signaling pathway. We conducted mutation analysis of RNF43 in intraductal papillary neoplasms of the bile duct (IPNBs) and identified RNF43 mutation in 6 (12%) out of 50 IPNBs. RNF43 mutation was more frequent in the intestinal subtype of IPNB (17%) than in the gastric/pancreatobiliary subtype (5%). There were a strong association of RNF43 mutation with GNAS (P = ...
November 16, 2016: Histopathology
https://www.readbyqxmd.com/read/27858562/multimodality-therapy-in-patients-with-borderline-resectable-or-locally-advanced-pancreatic-cancer-importance-of-locoregional-therapies-for-a-systemic-disease
#11
Susan Tsai, Kathleen K Christians, Paul S Ritch, Ben George, Abdul H Khan, Beth Erickson, Douglas B Evans
Historically, the clinical staging of pancreatic cancer has centered on the surgical management of the primary tumor, because few effective chemotherapeutic agents were available and long-term survival was only achieved in the context of surgical resection. Such a strategy of complete oncologic surgical care is reasonable when surgery is both the principal therapy and highly effective. However, complex surgery for pancreatic cancer-often performed in older patients after a lengthy period of induction therapy-can be associated with significant morbidity and mortality...
October 2016: Journal of Oncology Practice
https://www.readbyqxmd.com/read/27858559/cutting-through-confusion-multimodality-therapy-in-borderline-resectable-and-locally-advanced-pancreatic-cancer
#12
Gyulnara G Kasumova, Rebecca A Miksad, Jennifer F Tseng
No abstract text is available yet for this article.
October 2016: Journal of Oncology Practice
https://www.readbyqxmd.com/read/27828724/minimally-invasive-distal-pancreatectomy-review-of-the-english-literature
#13
Kai Wang, Ying Fan
BACKGROUND: Recently, the superiority of the minimally invasive approach, which results in a better cosmetic result, faster recovery, and shorter length of hospital stay, is a technique that has been progressively recognized as it has developed. And the minimally invasive approach has been applied to distal pancreatectomy (DP), which is a standard method for the treatment of benign, borderline, and part of malignant lesions of the pancreatic body and tail. This article aims to analyze the types, postoperative recovery, and outcomes of laparoscopic distal pancreatectomy (LDP)...
November 9, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/27813710/usefulness-of-three-dimensional-modeling-in-surgical-planning-resident-training-and-patient-education
#14
Ciro Andolfi, Alejandro Plana, Patrick Kania, P Pat Banerjee, Stephen Small
BACKGROUND: Imaging has a critical impact on surgical decision making and three-dimensional (3D) digital models of patient pathology can now be made commercially. We developed a 3D digital model of a cancer of the head of the pancreas by integrating actual CT data with 3D modeling process. After this process, the virtual pancreatic model was also produced using a high-quality 3D printer. PATIENTS AND METHODS: A 56-year-old female with pancreatic head adenocarcinoma presented with biliary obstruction and jaundice...
November 4, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/27778257/preoperative-therapy-and-pancreatoduodenectomy-for-pancreatic-ductal-adenocarcinoma-a-25-year-single-institution-experience
#15
Jordan M Cloyd, Matthew H G Katz, Laura Prakash, Gauri R Varadhachary, Robert A Wolff, Rachna T Shroff, Milind Javle, David Fogelman, Michael Overman, Christopher H Crane, Eugene J Koay, Prajnan Das, Sunil Krishnan, Bruce D Minsky, Jeffrey H Lee, Manoop S Bhutani, Brian Weston, William Ross, Priya Bhosale, Eric P Tamm, Huamin Wang, Anirban Maitra, Michael P Kim, Thomas A Aloia, Jean-Nicholas Vauthey, Jason B Fleming, James L Abbruzzese, Peter W T Pisters, Douglas B Evans, Jeffrey E Lee
BACKGROUND: The purpose of this study was to evaluate a single-institution experience with delivery of preoperative therapy to patients with pancreatic ductal adenocarcinoma (PDAC) prior to pancreatoduodenectomy (PD). METHODS: Consecutive patients (622) with PDAC who underwent PD following chemotherapy and/or chemoradiation between 1990 and 2014 were retrospectively reviewed. Preoperative treatment regimens, clinicopathologic characteristics, operative details, and long-term outcomes in four successive time periods (1990-1999, 2000-2004, 2005-2009, 2010-2014) were evaluated and compared...
October 24, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/27773618/copy-number-variants-and-vntr-length-polymorphisms-of-the-carboxyl-ester-lipase-cel-gene-as-risk-factors-in-pancreatic-cancer
#16
Monica Dalva, Khadija El Jellas, Solrun J Steine, Bente B Johansson, Monika Ringdal, Janniche Torsvik, Heike Immervoll, Dag Hoem, Felix Laemmerhirt, Peter Simon, Markus M Lerch, Stefan Johansson, Pål R Njølstad, Frank U Weiss, Karianne Fjeld, Anders Molven
BACKGROUND/OBJECTIVES: We have recently described copy number variants (CNVs) of the human carboxyl-ester lipase (CEL) gene, including a recombined deletion allele (CEL-HYB) that is a genetic risk factor for chronic pancreatitis. Associations with pancreatic disease have also been reported for the variable number of tandem repeat (VNTR) region located in CEL exon 11. Here, we examined if CEL CNVs and VNTR length polymorphisms affect the risk for developing pancreatic cancer. METHODS: CEL CNVs and VNTR were genotyped in a German family with non-alcoholic chronic pancreatitis and pancreatic cancer, in 265 German and 197 Norwegian patients diagnosed with pancreatic adenocarcinoma, and in 882 controls...
October 11, 2016: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
https://www.readbyqxmd.com/read/27760934/-neoadjuvant-chemotherapy-using-s-1-for-pancreatic-cancer-mid-term-results
#17
Yuki Homma, Goro Honda, Katsunori Sakamoto, Masanao Kurata, Masahiko Honjo, Yoshihiro Hirata, Satoshi Shinya
BACKGROUND: Although surgical resection is the only curative strategy for pancreatic cancer, the prognosis of patients with pancreatic cancer remains poor. Recently, neoadjuvant treatment has been frequently employed as a promising treatment. Here, the mid-term results of neoadjuvant chemoradiotherapy(NACRT)using S-1, which has been performed in our hospital since 2008, are reported. METHODS: Seventy-nine patients with resectable or borderline resectable pancreatic ductal adenocarcinoma, who had been intended to undergo NACRT treatment using S-1, were enrolled...
October 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/27760280/venous-thromboembolism-prophylaxis-during-neoadjuvant-therapy-for-resectable-and-borderline-resectable-pancreatic-cancer-is-it-indicated
#18
Ashley N Krepline, Kathleen K Christians, Ben George, Paul S Ritch, Beth A Erickson, Parag Tolat, Douglas B Evans, Susan Tsai
PURPOSE: To describe venous thromboembolism (VTE) rates in patients with pancreatic cancer (PC) during neoadjuvant therapy. METHODS: Factors associated with VTE were evaluated using multivariable logistic regression modeling in patients with resectable and BLR PC treated with neoadjuvant therapy between 2009 and 2014. RESULTS: Prevalent VTEs were detected in 13 (5%) of the 260 patients. Incident VTEs were detected in 26 patients (10%); 9 (8%) of the 109 resectable and 17 (11%) of the 151 BLR patients (P = 0...
October 2016: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/27740973/intraoperative-radiotherapy-in-the-era-of-intensive-neoadjuvant-chemotherapy-and-chemoradiotherapy-for-pancreatic-adenocarcinoma
#19
Florence K Keane, Jennifer Y Wo, Cristina R Ferrone, Jeffrey W Clark, Lawrence S Blaszkowsky, Jill N Allen, Eunice L Kwak, David P Ryan, Keith D Lillemoe, Carlos Fernandez-Del Castillo, Theodore S Hong
OBJECTIVES: Improved outcomes with FOLFIRINOX or gemcitabine with nab-paclitaxel in the treatment of metastatic pancreatic adenocarcinoma (PDAC) have prompted incorporation of these regimens into neoadjuvant treatment of locally advanced unresectable PDAC. Whereas some patients remain unresectable on surgical exploration, others are able to undergo resection after intensive neoadjuvant treatment. We evaluated outcomes and toxicity associated with use of intensive neoadjuvant treatment followed by intraoperative radiotherapy (IORT) in combination with resection or exploratory laparotomy...
October 12, 2016: American Journal of Clinical Oncology
https://www.readbyqxmd.com/read/27730398/preoperative-chemoradiation-for-pancreatic-adenocarcinoma-does-not-increase-90-day-postoperative-morbidity-or-mortality
#20
Jason W Denbo, Morgan L Bruno, Jordan M Cloyd, Laura Prakash, Jeffrey E Lee, Michael Kim, Christopher H Crane, Eugene J Koay, Sunil Krishnan, Prajnan Das, Bruce D Minsky, Gauri Varadhachary, Rachna Shroff, Robert Wolff, Milind Javle, Michael J Overman, David Fogelman, Thomas A Aloia, Jean-Nicolas Vauthey, Jason B Fleming, Matthew H G Katz
BACKGROUND: The impact of preoperative chemoradiation on postoperative morbidity and mortality of patients with pancreatic adenocarcinoma remains controversial. METHODS: Consecutive pancreatectomies for adenocarcinoma performed between 2011 and 2015 were prospectively monitored for 90 days by using a previously reported surveillance system to determine the association between preoperative chemoradiation and adverse events, pancreatic fistulae, readmissions, and mortality...
October 11, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
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