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Unresectable pancreas

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https://www.readbyqxmd.com/read/29451701/phase-1b-study-of-pasireotide-everolimus-and-selective-internal-radioembolization-therapy-for-unresectable-neuroendocrine-tumors-with-hepatic-metastases
#1
Hyun S Kim, Walid L Shaib, Chao Zhang, Ganji Purnachandra Nagaraju, Christina Wu, Olatunji B Alese, Zhengjia Chen, Edith Brutcher, Meredith Renfroe, Bassel F El-Rayes
BACKGROUND: Neuroendocrine tumors (NETs) metastasize to the liver. Everolimus and selective internal radioembolization (SIRT) are approved treatments. Pasireotide is a somatostatin analogue with an affinity for somatostatin receptors 1, 2, 3, and 5. Everolimus and pasireotide may potentiate SIRT radiosensitization and inhibit rebound angiogenesis. This study evaluated the safety of pasireotide, everolimus, and SIRT. METHODS: This 3 + 3 phase 1 trial evaluated 3 dose levels of everolimus (2...
February 16, 2018: Cancer
https://www.readbyqxmd.com/read/29423821/the-emerging-role-of-stereotactic-radiotherapy-in-gastrointestinal-malignancies-a-review-of-the-literature-and-analysis-from-the-irish-perspective
#2
Siobhra O'Sullivan, Daniel N Cagney
Primary and secondary malignancies of the liver and pancreas result in significant morbidity and mortality, with increasing incidence and increasing demands on health services worldwide. Surgery is the only curative single modality of treatment and remains the gold standard. Unfortunately, up to 80% of the patients present with unresectable disease, and so, alternative efficacious local and systemic treatments are needed. Technologic advances in radiotherapy over recent decades have meant that precision high-dose treatment with stereotactic body radiotherapy (SBRT) has emerged as a viable cost-effective outpatient-based treatment in the management of these difficult to treat abdominal malignancies...
February 8, 2018: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/29414805/a-novel-approach-for-hepatic-arterial-reconstruction-after-total-pancreatectomy-with-common-hepatic-artery-resection-using-inferior-phrenic-artery
#3
Takatsugu Matsumoto, Keiichi Kubota, Taku Aoki, Takayuki Shimizu, Shozo Mori, Masato Kato, Hirotaka Asato
BACKGROUND/AIMS: Because of the anatomical characteristics, pancreatic cancers (PC) can easily invade to visceral vessels such as celiac artery, superior mesenteric artery, common hepatic artery (CHA) and portal vein, which makes curative resection difficult. In this study, we report an R0 resection for locally advanced PC by total pancreatectomy, combined resection of CHA, and reconstruction of hepatic artery using autologous left inferior phrenic artery (IPA). METHODS: A 47-year-old woman with complaints of low back pain was referred to our department...
February 7, 2018: Digestive Surgery
https://www.readbyqxmd.com/read/29397891/modified-appleby-procedure-for-locally-advanced-pancreatic-cancer
#4
Shanley Deal, Derek Nathan, Flavio G Rocha
Locally advanced pancreas cancer (LAPC) involving the celiac axis is typically considered unresectable and carries a poor prognosis. We present a case of a patient with LAPC who underwent a modified Appleby procedure for tumor clearance following neoadjuvant therapy. Technical aspects include diagnostic laparoscopy to exclude occult metastatic disease followed by complete mobilization of the pancreas and spleen, preservation of the left gastric artery, and resection and reconstruction of the common hepatic artery...
January 10, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/29394847/-a-case-in-which-s-1-oxaliplatin-sox-trastuzumab-therapy-was-effective-for-unresectable-her2-positive-advanced-gastric-cancer-and-radical-resection-could-be-performed
#5
Hirotsugu Nagase, Kozo Noguchi, Atsushi Hamabe, Masashi Hirota, Kazuteru Oshima, Tsukasa Tanida, Yoshito Tomimaru, Tomono Kawase, Shunji Morita, Hiroshi Imamura, Takashi Iwazawa, Kenzo Akagi, Keizo Dono
The case was a 70s-year-old man. In July 2016, he was admitted to our hospital with a complaint of epigastralgia. Upper gastrointestinal endoscopy revealed type 3 advanced gastric cancer in the vestibule, directly infiltrating the pancreas and the left lobe of the liver to form an abscess, and swelling of the aortic lymph node and multiple liver metastases were observed. The cancer was diagnosed as cT4b(liver/pancreas), N2M1(H1P0CYX), cStage IV and diagnosed it as a chemotherapy policy. We initiated SOX plus trastuzumab therapy from August 2016...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29394800/-a-case-of-unresectable-locally-advanced-pancreatic-cancer-resulted-in-r0-surgery-after-chemotherapy
#6
Yu Sasaki, Hokahiro Katayama, Yohei Hosoda, Izumi Komoto, Takashi Sugimoto, Kazuhiro Yanagihara, Utae Katsushima, Jun Kawai, Hidenori Kiyochi, Kazuhiro Nishiyama, Asami Okabe, Yu Oshima, Shoji Tsunekawa, Nobuko Ogura, Yoshiro Taki
A 67-year-old man visited our hospital for jaundice. Abdominal dynamic CT showed the hypovascular tumor at the head of the pancreas that surrounded superior mesenteric artery(SMA)at an angle of 220 degree. No metastasis in lymph nodes and other organs was observed. We diagnosed the tumor unresectable locally advanced(UR-LA)pancreatic cancer. Chemotherapy was administered with gemcitabine and nab-paclitaxel(GEM+nab-PTX)and achieved partial response. Regression in size and in range around SMA to an angle of 150 was observed...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29394692/-a-case-of-locally-advanced-neuroendocrine-carcinoma-of-the-stomach-could-be-curably-resected-after-chemotherapy-with-cpt-11-cddp
#7
Tomoki Kido, Yuta Morimoto, Hiroshi Toda, Kei Yoshino, Hiroshi Imano, Toshiki Sasaki, Yoshihiko Kimura, Reijiro Saito, Kazuhiko Endo
A 64-year-old man was admitted to our hospital because of epigastralgia. Gastrointestinal endoscopyrevealed a submucosal tumor with ulceration in the upper bodyof the stomach. The tumor was histologicallydiagnosed as a neuroendocrine carcinoma. CT showed that the tumor had directlyinfiltrated the pancreas and splenic vessels. The patient underwent onlyan exploratorylaparotomybecause the tumor seemed to involve the celiac artery. Chemotherapywas conducted using CPT-11/ CDDP. After 15 courses of chemotherapy, a significant tumor reduction was obtained...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29394630/-neoadjuvant-folfirinox-for-unresectable-adenocarcinoma-of-the-pancreas-a-case-report
#8
Toshiya Ochiai, Hiroyuki Inoue, Hiroki Nakatsuji, Nobuyuki Watanabe, Atsushi Yoshiyama, Hiroshi Ito, Atsushi Toma, Kenji Nakamura
A 38-year-old male presented to our hospital with complaint of vomiting. A CT demonstrated a mass sized 42mm in the pancreatic head invading to the duodenum and a liver mass sized 15mm in the medial segment. Biopsy revealed adenocarcinoma. Due to liver metastasis, he was deemed surgically unresectable. He was started on FOLFIRINOX therapy after gastrojejunum bypass operation. After 15 courses of the therapy, restaging showed a decrease in pancreatic tumor size and a disappearance of a liver mass along with PET-CT revealing no FDG-avid uptake...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29394594/-multidisciplinary-therapy-with-gemcitabine-and-nab-paclitaxel-for-unresectable-pancreatic-cancer
#9
Fuyuhiko Motoi, Tatsuyuki Takadate, Shimpei Maeda, Kyohei Ariake, Kunihiro Masuda, Masaharu Ishida, Koji Fukase, Masamichi Mizuma, Hideo Ohtsuka, Naoaki Sakata, Hiroki Hayashi, Kei Nakagawa, Takanori Morikawa, Takeshi Naitoh, Michiaki Unno
Gemcitabine with nab-paclitaxel(GN)shows promisinganti -tumor effect and has been established standard regimen for metastatic pancreatic cancer(PC). Conversion surgery(CS), recently reported about initially unresectable PC with favorable response to non-surgical treatment, might provide long-term survival. The aim of this study is to evaluate the efficacy of multi-modal treatment includingCS after GN therapy for initially unresectable PC. From 2015 to 2016, 29 initially unresectable PC treated with chemotherapy includingGN were eligible for the retrospective analysis...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29282381/a-silent-asymptomatic-solid-pancreas-tumor-in-a-nonsmoking-athletic-female-pancreatic-ductal-adenocarcinoma
#10
Kyawzaw Lin, Aung Naing Lin, Sithu Lin, Thinzar Lin, Ying Xian Liu, Madhavi Reddy
A silent solid endocrine tumor of pancreas, intraductal adenocarcinoma of pancreas, is the fourth leading cancer-related death in the US. However, it is expected to become the third leading cause by 2030 owing to delayed diagnosis and slow progress in management. Chronic pancreatitis is at risk for pancreatic ductal adenocarcinoma (PDAC). PDAC is diagnostic with transabdominal sonogram, blood test such as carbohydrate antigen 19-9 (CA 19-9), and imaging. PDAC has a dismal prognosis. The survival rate in 5 years is barely 6%, while late detection rate is 80-85% with unresectable stage upon diagnosis...
September 2017: Case Reports in Gastroenterology
https://www.readbyqxmd.com/read/29235221/liver-transplant-for-metastatic-pancreatoblastoma-7-year-event-free-survival-after-chemotherapy-pancreatectomy-complete-hepatectomy-and-liver-transplant
#11
A A Ghaffarian, L Book, R L Meyers
Pancreatoblastoma is a rare malignant tumor in children. Surgical resection of the tumor is necessary for cure; however, due to its aggressive nature, it is often unresectable at presentation due to tumor size, local invasion, and/or metastasis. Because it is a rare tumor, there is currently no standard treatment regimen. We report a case of a 4-year-old boy who presented with metastatic pancreatoblastoma with multiple large metastases involving all four sectors of the liver. We began treatment with chemotherapy (cisplatin, 5FU, vincristine, and doxorubicin), which significantly reduced the tumor burden in both the pancreas and liver...
December 13, 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/29229121/efficacy-of-completion-pancreatectomy-for-recurrence-of-adenocarcinoma-in-the-remnant-pancreas
#12
Yusuke Nakayama, Motokazu Sugimoto, Naoto Gotohda, Masaru Konishi, Shinichiro Takahashi
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer, with a high rate of recurrence even after complete surgical resection. The aim of this study was to investigate the impact of completion pancreatectomy (CP) on the clinical course of patients with recurrent PDAC in the remnant pancreas. MATERIALS AND METHODS: Between January 2008 and December 2014, 194 patients underwent curative-intent surgical resection (initial pancreatectomy [IP]) for PDAC at our institution...
January 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29212734/predictors-of-response-and-survival-in-locally-advanced-adenocarcinoma-of-the-pancreas-following-neoadjuvant-gtx-with-or-without-radiation-therapy
#13
William H Sherman, Elizabeth Hecht, David Leung, Kyung Chu
LESSONS LEARNED: There is no presenting parameter that predicts the success of neoadjuvant therapy for pancreatic cancer.Despite the images on scans following neoadjuvant therapy, all patients should be evaluated, because inflammation following radiation therapy (RT) may overstate the extent of tumor and vascular involvement. BACKGROUND: In patients presenting with locally advanced pancreatic adenocarcinoma deemed unresectable by two pancreatic cancer surgeons, we analyzed presenting tumor size, extent of vascular involvement, tumor markers, response to neoadjuvant gemcitabine (G), docetaxel (T), and capecitabine (X) with or without additional chemoradiotherapy with GX on R0 resection rates (≥2 mm margins), and survival...
December 6, 2017: Oncologist
https://www.readbyqxmd.com/read/29152519/primary-carcinosarcoma-of-the-pancreas-with-cd10-positive-sarcoma-component
#14
Christine J Salibay, Julia Rewerska, Shweta Gupta, Nicholas Ree
Carcinosarcomas of the pancreas are rare entities with a dismal prognosis. We report a rare case of pancreatic carcinosarcoma in a 49-year-old African American female who underwent a total abdominal hysterectomy with right salpingo-oophorectomy and exploration of the pancreatic mass. The surgery revealed a sclerotic mass in the body and tail of the pancreas that was surgically unresectable, and a pancreatic biopsy confirmed the pathology of pancreatic carcinosarcoma. Histologically, the lesion showed a high-grade spindle cell sarcoma and adjacent moderately differentiated adenocarcinoma...
October 2017: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/29051982/irreversible-electroporation-of-pancreatic-adenocarcinoma-a-primer-for-the-radiologist
#15
M Farzan Rashid, Elizabeth M Hecht, Jonathan A Steinman, Michael D Kluger
Irreversible electroporation (IRE) is increasingly used for the ablation of unresectable locally advanced pancreatic adenocarcinoma. Unlike other ablation technologies that cannot be safely used around critical vasculature or ducts for risk of thermal damage, IRE uses high-voltage pulses to disrupt cellular membranes. This causes cell death by apoptosis and inflammation. IRE has been deployed by both open and percutaneous approaches. Generator parameters are the same for both approaches, and settings are pancreas specific...
October 19, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/29046787/relapsed-and-unresectable-inflammatory-myofibroblastic-tumor-responded-to-chemotherapy-a-case-report-and-review-of-the-literature
#16
Yasuhiro Maruyama, Toshirou Fukushima, Daisuke Gomi, Takashi Kobayashi, Nodoka Sekiguchi, Akiyuki Sakamoto, Shigeru Sasaki, Keiko Mamiya, Tomonobu Koizumi
A 63-year-old female patient who had undergone cholecystectomy for inflammatory myofibroblastic tumor (IMT) in the gallbladder was referred to our hospital. The patient's disease relapsed, involving the pancreas, and was diagnosed as inoperable IMT 13 months after the cholecystectomy. The patient failed to respond to steroid and non-steroidal anti-inflammatory drug therapy, but subsequently exhibited a good response to vinorelbine and methotrexate combination chemotherapy. Little information is currently available on the efficacy of chemotherapy for adult-onset IMT...
October 2017: Molecular and Clinical Oncology
https://www.readbyqxmd.com/read/28948329/surgery-for-pancreatic-cancer-critical-radiologic-findings-for-clinical-decision-making
#17
Annabelle L Fonseca, Jason B Fleming
Pancreatic cancer is the fourth leading cause of cancer-related deaths in the United States, with an estimated 53,670 new cases diagnosed and an estimated 43,090 deaths in 2017. This high mortality rate is in part due to the small percentage of patients diagnosed with local disease, as well as the biologically aggressive nature of the disease. While only 10-20% of patients will present with surgically resectable disease, this is the only possible curative therapy. Five-year survival of resected pancreatic cancer ranges from 12 to 27%...
September 25, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/28943075/a-novel-absorbable-radiopaque-hydrogel-spacer-to-separate-the-head-of-the-pancreas-and-duodenum-in-radiation-therapy-for-pancreatic-cancer
#18
Avani D Rao, Ziwei Feng, Eun Ji Shin, Jin He, Kevin M Waters, Stephanie Coquia, Robert DeJong, Lauren M Rosati, Lin Su, Dengwang Li, Juan Jackson, Stephen Clark, Jeffrey Schultz, Danielle Hutchings, Seong-Hun Kim, Ralph H Hruban, Theodore L DeWeese, John Wong, Amol Narang, Joseph M Herman, Kai Ding
PURPOSE: We assessed the feasibility and theoretical dosimetric advantages of an injectable hydrogel to increase the space between the head of the pancreas (HOP) and duodenum in a human cadaveric model. METHODS AND MATERIALS: Using 3 human cadaveric specimens, an absorbable radiopaque hydrogel was injected between the HOP and duodenum by way of open laparotomy in 1 case and endoscopic ultrasound (EUS) guidance in 2 cases. The cadavers were subsequently imaged using computed tomography and dissected for histologic confirmation of hydrogel placement...
December 1, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28941969/case-report-irreversible-electroporation-for-locally-advanced-pancreatic-cancer
#19
Sonia Orcutt, Bela Kis, Mokenge Malafa
INTRODUCTION: For patients with pancreatic adenocarcinoma who are not candidates for surgical resection, long-term survival is poor, even with currently available systemic and radiation therapy options. However, for those with locally advanced disease who do not have distant metastasis, locoregional control of the tumor has the potential to improve long-term outcomes. A newly developed technology, irreversible electroporation, has advantages over traditional thermal ablation with unresectable cancers in this location...
2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28739282/long-term-risk-of-pancreatic-malignancy-in-patients-with-branch-duct-intraductal-papillary-mucinous-neoplasm-in-a-referral-center
#20
Ilaria Pergolini, Klaus Sahora, Cristina R Ferrone, Vicente Morales-Oyarvide, Brian M Wolpin, Lorelei A Mucci, William R Brugge, Mari Mino-Kenudson, Manuel Patino, Dushyant V Sahani, Andrew L Warshaw, Keith D Lillemoe, Carlos Fernández-Del Castillo
BACKGROUND & AIMS: Little is known about the development of branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). We evaluated long-term outcomes of a large cohort of patients with BD-IPMNs to determine risk of malignancy and define a subset of low-risk BD-IPMNs. METHODS: We performed a retrospective analysis of data from 577 patients with suspected or presumed BD-IPMN under surveillance at the Massachusetts General Hospital. Patients underwent cross-sectional imaging analysis at 3 months or later after their initial diagnosis...
November 2017: Gastroenterology
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