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Unresectable pancreas

Perparim Limani, Michael Linecker, Philipp Kron, Panagiotis Samaras, Bernhard Pestalozzi, Roger Stupp, Alexander Jetter, Philipp Dutkowski, Beat Müllhaupt, Andrea Schlegel, Claude Nicolau, Jean-Marie Lehn, Henrik Petrowsky, Bostjan Humar, Rolf Graf, Pierre-Alain Clavien
BACKGROUND: Solid tumors, such as hepato-pancreato-biliary cancer, develop tumor hypoxia with tumor growth. Despite advances in surgery, a majority of these patients are in an unresectable condition. At this stage standard cytotoxic chemotherapy regimens are applied with limited success. Novel biological treatment options based on an antiangiogenic mechanism of action neglect other hypoxia mediated mechanisms (e.g. epithelial-mesenchymal transition, Warburg effect, and immunological response) leading to an increased invasiveness with a poor outcome...
October 19, 2016: BMC Cancer
E Bertani, N Fazio, D Radice, C Zardini, G Spinoglio, A Chiappa, D Ribero, R Biffi, S Partelli, M Falconi
BACKGROUND: The role of primary tumour surgery in pancreatic neuroendocrine tumours (PNETs) with unresectable liver metastases is controversial and international guidelines do not recommend surgery in such cases. Resectability of the primary tumour has never been considered in outcome comparisons between operated and non-operated patients. METHODS: From two institutional prospective databases of patients affected by PNET and unresectable liver metastases, 63 patients who underwent a left-pancreatectomy at diagnosis were identified and compared with a group of 30 patients with a potentially resectable but not-resected primary tumour located in the body or tail...
September 30, 2016: European Journal of Surgical Oncology
Masaoki Sasaki, Hiroaki Izumi, Takaaki Yokoyama, Motohiro Kojima, Ako Hosono
Follicular dendritic cell sarcoma (FDCS) is a very rare malignant tumor derived from follicular dendritic cells. Radical resection is the standard therapy for patients with local disease, but an optimal chemotherapy regimen has not been determined for unresectable disease. We report our experience of an FDCS patient with multiorgan involvement. In the present case, disease was only located in the pancreas initially and radical resection was performed. Multiple metastasis developed after the treatment and several factors that indicated a poor prognosis were observed...
October 13, 2016: Hematological Oncology
Domenico Tamburrino, Deniece Riviere, Mohammad Yaghoobi, Brian R Davidson, Kurinchi Selvan Gurusamy
BACKGROUND: Periampullary cancer includes cancer of the head and neck of the pancreas, cancer of the distal end of the bile duct, cancer of the ampulla of Vater, and cancer of the second part of the duodenum. Surgical resection is the only established potentially curative treatment for pancreatic and periampullary cancer. A considerable proportion of patients undergo unnecessary laparotomy because of underestimation of the extent of the cancer on computed tomography (CT) scanning. Other imaging methods such as magnetic resonance imaging (MRI), positron emission tomography (PET), PET-CT, and endoscopic ultrasound (EUS) have been used to detect local invasion or distant metastases not visualised on CT scanning which could prevent unnecessary laparotomy...
September 15, 2016: Cochrane Database of Systematic Reviews
Tarun Rustagi, Ferga C Gleeson, Suresh T Chari, Barham K Abu Dayyeh, Michael B Farnell, Prasad G Iyer, Michael L Kendrick, Randall K Pearson, Bret T Petersen, Elizabeth Rajan, Mark D Topazian, Mark J Truty, Santhi S Vege, Kenneth K Wang, Michael J Levy
Synchronous primary pancreatic adenocarcinoma, defined as the simultaneous presence of 2 or more newly identified and anatomically separate primary adenocarcinomas within the pancreas, is rarely reported. We compared endoscopic ultrasound (EUS) and computed tomography (CT) and magnetic resonance imaging (MRI) findings from patients with synchronous primary pancreatic adenocarcinoma and their effects on cancer staging and treatment. We performed a retrospective analysis of the EUS database at the Mayo Clinic, from September 2008 through May 2016, to collect EUS, CT, MRI, and clinical data from patients with synchronous primary pancreatic adenocarcinoma...
August 15, 2016: Clinical Gastroenterology and Hepatology
William Small, John P Hayes, W Warren Suh, May Abdel-Wahab, Ross A Abrams, Nilofer Azad, Prajnan Das, Jadranka Dragovic, Karyn A Goodman, Salma K Jabbour, William E Jones, Andre A Konski, Albert C Koong, Rachit Kumar, Percy Lee, Timothy M Pawlik, Joseph M Herman
The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment...
July 2016: Oncology (Williston Park, NY)
Junpei Sasajima, Kotaro Okamoto, Masato Taniguchi
While the gastric involvement of pancreatic cancer is occasionally observed as the result of direct invasion, hematogenous gastric metastasis is rare. A 72-year-old Japanese male presented with general fatigue, pollakiuria, and thirst. Computed tomography revealed a 4.6-cm solid mass in the pancreatic tail and a 4.2-cm multilocular cystic mass in the pancreatic head with multiple liver and lymphatic metastasis. Notably, two solid masses were detected in the gastric wall of the upper body and the antrum; both were separated from the primary pancreatic cancer and seemed to be located in the submucosal layer...
January 2016: Case Reports in Gastroenterology
Takeshi Hatanaka, Takao Itoi, Masashi Ijima, Ayako Matsui, Eishin Kurihara, Nozomi Okuno, Tsutomu Kobatake, Satoru Kakizaki, Masanobu Yamada
Objective Endoscopic gallbladder stenting (EGBS) is an alternative treatment option for high-risk surgical patients with acute cholecystitis. However, there are no reports focusing on EGBS in patients with concomitant unresectable cancer. The aim of this study was thus to evaluate EGBS in such patients. Methods Twenty-two consecutive patients with acute cholecystitis and unresectable cancer were enrolled between September 2010 and December 2014. Their median age was 74.5 years (range: 51-95). Thirteen patients were men and nine were women...
2016: Internal Medicine
Przemysław Dyrla, Tomasz Nowak, Jerzy Gil, Cezary Adamiec, Mariusz Bobula, Marek Saracyn
Autoimmune pancreatitis constantly belongs to diseases which often causes significant diagnostic problem and often runs out with surgical intervention as considered to be a pancreatic cancer. Important although usually underestimated problems are polyglandular syndromes, which may consist of autoimmune pancreatitis (AIP) problem as well. This case report is an example of autoimmune polyglandular syndrome (APS), which was connected with the surgical treatment with biliary bypass anastomosis because of the unresectable lesion in the head of pancreas...
May 2016: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
Michael Linecker, Thomas Pfammatter, Patryk Kambakamba, Michelle L DeOliveira
With the advent of novel and somewhat effective chemotherapy against pancreas cancer, several groups developed a new interest on locally advanced pancreatic cancer (LAPC). Unresectable tumors constitute up to 80% of pancreatic cancer (PC) at the time of diagnosis and are associated with a 5-year overall survival of less than 5%. To control those tumors locally, with perhaps improved patients survival, significant advances were made over the last 2 decades in the development of ablation methods including cryoablation, radiofrequency ablation, microwave ablation, high intensity focused ultrasound and irreversible electroporation (IRE)...
2016: Digestive Surgery
John M Ruggero, Shivana N Prakash
Lymphoepithelial cysts (LECs) of the pancreas are rare benign lesions with unknown pathogenesis. LECs are true cysts that mimic pseudocysts and cystic neoplasms making diagnosis challenging. We report a case of a symptomatic LEC of the pancreas in a 67-year-old man who had severe epigastric pain. Workup including computed tomography and endoscopic ultrasound were non-diagnostic. The patient underwent attempted surgical resection; however, the mass was unresectable. The mass was enucleated and drained, and pathology returned LEC...
2016: Journal of Surgical Case Reports
Rei Suzuki, Tadayuki Takagi, Takuto Hikichi, Naoki Konno, Mitsuru Sugimoto, K O Watanabe, Jun Nakamura, Yuichi Waragai, Hitomi Kikuchi, Mika Takasumi, Hiroshi Watanabe, Hiromasa Ohira
As gemcitabine is a key anti-tumor agent for unresectable pancreatic ductal adenocarcinoma (PDAC), it is important to predict the outcomes of gemcitabine chemotherapy. The present study aimed to confirm whether the derived neutrophil-to-lymphocyte ratio (dNLR) is able to predict chemotherapy outcomes. To elucidate the role of dNLR in patients that underwent chemotherapy, the current study evaluated clinicopathological variables in 31 patients with unresectable PDAC treated with gemcitabine. The correlation between clinicopathological variables, and progression-free survival (PFS) and overall survival (OS) time were investigated...
May 2016: Oncology Letters
Sunpreet Rakhra, Jonathan B Strauss, John Robertson, Cornelius J McGinn, Thomas Kim, Jiayi Huang, Andrew Blake, Irene Helenowski, John P Hayes, Mary Mulcahy, William Small
PURPOSE/OBJECTIVE(S): The purpose of this study was to compare oncologic outcomes and toxicity profile of hypofractionated conformal radiotherapy (RT) with concurrent full-dose gemcitabine versus standard fractionation RT with concurrent 5-fluorouracil (5-FU) in the treatment of unresectable non-metastatic pancreatic cancer. MATERIALS/METHODS: Patients with unresectable non-metastatic adenocarcinoma of the pancreas treated at three institutions were included. All patients were treated with chemoradiotherapy (CRT) consisting of either hypofractionated RT to the gross disease concurrent with a full-dose gemcitabine-based regimen versus standard fractionation RT to the tumor and elective nodes concurrent with 5-FU...
June 2016: Journal of Gastrointestinal Cancer
Katherine E Poruk, Christopher L Wolfgang
Pancreatic adenocarcinoma is the fourth leading cause of cancer death in the United States. Surgical resection offers the best opportunity for prolonged survival but is limited to patients with locally resectable disease without distant metastases. Regrettably, most patients are diagnosed at a point in which curative surgery is no longer a treatment option. In these patients, management of symptoms becomes paramount to improve quality of life and potentially increase survival. This article reviews the palliative management of unresectable pancreatic cancer, including potential palliative resection, surgical and endoscopic biliary and gastric decompression, and pain control with celiac plexus block...
April 2016: Surgical Oncology Clinics of North America
Sten Myrehaug, Arjun Sahgal, Suzanne M Russo, Simon S Lo, Lauren M Rosati, Nina A Mayr, Michael Lock, William Small, Jennifer A Dorth, Rodney J Ellis, Bin S Teh, Joseph M Herman
Despite advances in surgical, medical, and radiation therapy for pancreatic cancer, the prognosis remains poor. At this time, the only chance for long-term survival is surgical resection. More challenging is the optimal management of unresectable locally advanced pancreatic cancer, which has historically been treated with concurrent chemoradiation or chemotherapy alone. However, the survival and local control benefit of conventional radiotherapy in addition to chemotherapy was unclear. More recently, stereotactic body radiotherapy (SBRT) is emerging as a viable approach to maximizing local tumor control with a tolerable side effect profile...
May 2016: Expert Review of Anticancer Therapy
Xiaoyu Liu, Xuerong Yang, Guofeng Zhou, Yi Chen, Changyu Li, Xiaolin Wang
The present study was carried out to investigate the prognostic factors in patients who received intra-arterial infusion for advanced pancreatic cancer. In addition, the detailed procedure of intra-arterial infusion chemotherapy was described. A total of 354 patients with advanced unresectable pancreatic adenocarcinoma were recruited from January 2012, to April 2015, at Zhongshan Hospital Fudan University, Shanghai, China. Demographic and clinic characteristics of the patients were extracted from electronic medical records...
March 2016: Medicine (Baltimore)
Anna Caterina Milanetto, Valbona Liço, Stella Blandamura, Claudio Pasquali
BACKGROUND: First described by Ross in 1951, primary pancreatic leiomyosarcoma is a rare mesenchymal tumour of the pancreas, with nonspecific clinical and radiological features and a poor prognosis, if unresectable. CASE REPORT: A 60-year-old woman presented with abdominal pain. Magnetic resonance imaging (MRI) and computed tomography (CT) scan detected a dishomogeneous egg-shaped 8-cm mass, arising from the pancreatic head, with duodenal compression, without dilation of the Wirsung duct...
December 2015: Surgical Case Reports
Nergiz Dagoglu, Mark Callery, James Moser, Jennifer Tseng, Tara Kent, Andrea Bullock, Rebecca Miksad, Joseph D Mancias, Anand Mahadevan
OBJECTIVES: After adjuvant or definitive radiation for pancreas cancer, there are limited conventional treatment options for recurrent pancreas cancer. We explored the role of (Stereotactic Body Radiotherapy) SBRT for reirradiation of recurrent pancreas Cancer. METHODS: This is a retrospective study of patients reirradiated with SBRT for recurrent pancreas cancer. All patients were deemed unresectable and treated with systemic therapy. Fiducial gold markers were used...
2016: Journal of Cancer
Tracey L Smith, Ziqiang Yuan, Marina Cardó-Vila, Carmen Sanchez Claros, Asha Adem, Min-Hui Cui, Craig A Branch, Juri G Gelovani, Steven K Libutti, Richard L Sidman, Renata Pasqualini, Wadih Arap
Patients with inoperable or unresectable pancreatic neuroendocrine tumors (NETs) have limited treatment options. These rare human tumors often express somatostatin receptors (SSTRs) and thus are clinically responsive to certain relatively stable somatostatin analogs, such as octreotide. Unfortunately, however, this tumor response is generally short-lived. Here we designed a hybrid adeno-associated virus and phage (AAVP) vector displaying biologically active octreotide on the viral surface for ligand-directed delivery, cell internalization, and transduction of an apoptosis-promoting tumor necrosis factor (TNF) transgene specifically to NETs...
March 1, 2016: Proceedings of the National Academy of Sciences of the United States of America
Makoto Shinoto, Shigeru Yamada, Kotaro Terashima, Shigeo Yasuda, Yoshiyuki Shioyama, Hiroshi Honda, Tadashi Kamada, Hirohiko Tsujii, Hiromitsu Saisho
PURPOSE: To determine, in the setting of locally advanced pancreatic cancer, the maximum tolerated dose of carbon ion radiation therapy (C-ion RT) and gemcitabine dose delivered concurrently and to estimate local effect and survival. METHODS AND MATERIALS: Eligibility included pathologic confirmation of pancreatic invasive ductal carcinomas and radiographically unresectable disease without metastasis. Concurrent gemcitabine was administered on days 1, 8, and 15, and the dose levels were escalated from 400 to 1000 mg/m(2) under the starting dose level (43...
May 1, 2016: International Journal of Radiation Oncology, Biology, Physics
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