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Locally advanced pancreatic cancer

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https://www.readbyqxmd.com/read/28069017/dose-escalation-of-stereotactic-body-radiotherapy-sbrt-for-locally-advanced-unresectable-pancreatic-cancer-patients-with-cyberknife-protocol-of-a-phase-i-study
#1
Shui-Wang Qing, Xiao-Ping Ju, Yang-Sen Cao, Huo-Jun Zhang
BACKGROUND: Dose escalation of SBRT for locally advanced pancreatic cancer patients had been reported in several studies in one or three fractions, and phase I protocol was developed to investigate the maximum tolerated dose with CyberKnife for locally advanced unresectable pancreatic cancer patients in five fractions. METHODS: The study is designed as a mono-center phase I study. The primary endpoint is to determine the maximum tolerated dose by frequency of III/IV GI (gastrointestinal) toxicity...
January 9, 2017: Radiation Oncology
https://www.readbyqxmd.com/read/28068240/does-unintentional-splenic-radiation-predict-outcomes-after-pancreatic-cancer-radiation-therapy
#2
Awalpreet S Chadha, Guan Liu, Hsiang-Chun Chen, Prajnan Das, Bruce D Minsky, Usama Mahmood, Marc E Delclos, Yelin Suh, Gabriel O Sawakuchi, Sam Beddar, Matthew H Katz, Jason B Fleming, Milind M Javle, Gauri R Varadhachary, Robert A Wolff, Christopher H Crane, Xuemei Wang, Howard Thames, Sunil Krishnan
PURPOSE: To determine whether severity of lymphopenia is dependent on radiation dose and fractional volume of spleen irradiated unintentionally during definitive chemoradiation (CRT) in patients with locally advanced pancreatic cancer (LAPC). METHODS: 177 patients with LAPC received induction chemotherapy (mainly gemcitabine-based regimens) followed by CRT (median 50.4 Gy with concurrent capecitabine) from January 2006 to December 2012. Absolute lymphocyte count (ALC) was recorded at baseline, before CRT, and 2 to 10 weeks after CRT...
February 1, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28068239/stereotactic-body-radiation-therapy-for-locally-advanced-pancreatic-cancer-a-systematic-review-and-pooled-analysis-of-19-trials
#3
REVIEW
Fausto Petrelli, Tiziana Comito, Antonio Ghidini, Valter Torri, Marta Scorsetti, Sandro Barni
PURPOSE: Although surgery is the standard of care for resectable pancreatic cancer (PC), standard-dose chemoradiation therapy and chemotherapy alone are suitable for patients with unresectable disease. Stereotactic body radiation therapy (SBRT) is an alternative, focused local therapy that delivers high radiation doses within a few fractions to the cancer, sparing the surrounding critical tissue. We performed a systematic review and pooled analysis of published trials to evaluate the efficacy and safety of this emerging treatment modality...
February 1, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28062950/efficacy-and-safety-of-folfirinox-in-locally-advanced-pancreatic-cancer-a-single-center-experience
#4
G Lakatos, A Petranyi, A Szűcs, L Nehéz, L Harsanyi, P Hegyi, G Bodoky
The management of locally advanced pancreatic cancer (LAPC) is a major challenge. Although new drugs are available for the treatment of metastatic disease, the optimal treatment of non-metastatic cases remains controversial. The role of neoadjuvant therapy is still a question of debate in this setting. The aim of the study was to prospectively collect and analyse data on efficacy and safety of a modified FOLFIRINOX regimen in LAPC patients treated in a single institution. Another major objective was to assess the capability of FOLFIRINOX to render primary non-resectable cancer to resectable...
January 6, 2017: Pathology Oncology Research: POR
https://www.readbyqxmd.com/read/28056913/prognostic-relevance-of-lactate-dehydrogenase-in-advanced-pancreatic-ductal-adenocarcinoma-patients
#5
Yuanyuan Xiao, Wen Chen, Zhihui Xie, Zhenyi Shao, Hua Xie, Guoyou Qin, Naiqing Zhao
BACKGROUND: The prognostic role of pretreatment serum lactate dehydronegase (LDH) has been well established in many malignant tumors, albeit it remains under-discussed in pancreatic cancer. In the present study, we aimed to assess the association between baseline LDH levels and overall survival (OS) in advanced pancreatic ductal adenocarcinoma (PDAC) patients who did and did not receive subsequent chemotherapy. METHODS: In total, 135 retrospectively determined patients with locally advanced or metastatic PDAC, who were diagnosed between 2012 and 2013, were analyzed...
January 6, 2017: BMC Cancer
https://www.readbyqxmd.com/read/28052102/irreversible-electroporation-of-the-pancreas-using-parallel-plate-electrodes-in-a-porcine-model-a-feasibility-study
#6
Steffi J E Rombouts, Maarten W Nijkamp, Willemijn P M van Dijck, Lodewijk A A Brosens, Maurits Konings, R van Hillegersberg, Inne H M Borel Rinkes, Jeroen Hagendoorn, Fred H Wittkampf, I Quintus Molenaar
BACKGROUND: Irreversible electroporation (IRE) with needle electrodes is being explored as treatment option in locally advanced pancreatic cancer. Several studies have shown promising results with IRE needles, positioned around the tumor to achieve tumor ablation. Disadvantages are the technical difficulties for needle placement, the time needed to achieve tumor ablation, the risk of needle track seeding and most important the possible occurrence of postoperative pancreatic fistula via the needle tracks...
2017: PloS One
https://www.readbyqxmd.com/read/28049283/application-of-photodynamic-therapy-in-gastrointestinal-disorders-an-outdated-or-re-emerging-technique
#7
REVIEW
Han Hee Lee, Myung-Gyu Choi, Tayyaba Hasan
Photodynamic therapy (PDT) is a promising therapeutic modality that involves the administration of a photosensitizer followed by local illumination with a specific wavelength of light in the presence of oxygen. PDT is minimally invasive, has high selectivity for cancer, and has good patient compliance due to the simplicity of the procedure; therefore, PDT is widely used as a palliative and salvage treatment in patients with various gastrointestinal malignancies. When used as a salvage treatment for locoregional failures after definitive chemoradiotherapy for esophageal cancer, favorable results have been reported...
January 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/28048725/su-f-t-108-texture-analysis-for-toxicity-prediction-from-dose-surface-maps
#8
A Witztum, S Warren, M Partridge, M Hawkins
PURPOSE: To find spatial features that best predict acute duodenal related toxicity grade ≥ 3 from 2D dose surface maps in pancreatic chemoradiotherapy. METHODS: Nineteen patients from the ARCII trial (EudraCT 2008-006302-42) treating locally-advanced pancreatic cancer (LAPC) with chemoradiotherapy were analysed. Previous work considering traditional dose-volume and dose-surface metrics as predictors had little power. We investigate the use of texture analysis to improve predictive capabilities...
June 2016: Medical Physics
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
#9
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/28047083/su-c-bra-01-interactive-auto-segmentation-for-bowel-in-online-adaptive-mri-guided-radiation-therapy-by-using-a-multi-region-labeling-algorithm
#10
Y Lu, I Chen, R Kashani, H Wan, N Maughan, D Muccigrosso, P Parikh
PURPOSE: In MRI-guided online adaptive radiation therapy, re-contouring of bowel is time-consuming and can impact the overall time of patients on table. The study aims to auto-segment bowel on volumetric MR images by using an interactive multi-region labeling algorithm. METHODS: 5 Patients with locally advanced pancreatic cancer underwent fractionated radiotherapy (18-25 fractions each, total 118 fractions) on an MRI-guided radiation therapy system with a 0.35 Tesla magnet and three Co-60 sources...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28046491/su-c-brb-02-automatic-planning-as-a-potential-strategy-for-dose-escalation-for-pancreas-sbrt
#11
S Wang, D Zheng, R Ma, C Lin, X Zhu, Y Lei, C Enke, S Zhou
PURPOSE: Stereotactic body radiation therapy (SBRT) has been suggested to provide high rates of local control for locally advanced pancreatic cancer. However, the close proximity of highly radiosensitive normal tissues usually causes the labor-intensive planning process, and may impede further escalation of the prescription dose. The present study evaluates the potential of an automatic planning system as a dose escalation strategy. METHODS: Ten pancreatic cancer patients treated with SBRT were studied retrospectively...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28040425/safety-and-efficacy-of-folfirinox-in-elderly-patients-with-metastatic-or-locally-advanced-pancreatic-adenocarcinoma-a-retrospective-analysis
#12
C Baldini, A Escande, O Bouché, F El Hajbi, J Volet, V Bourgeois, T Renaut Vantroys, A Ploquin, C Desauw, M Hebbar
BACKGROUND: FOLFIRINOX is a polychemotherapy regimen currently used to treat inoperable pancreatic cancer in patients with a good performance status (PS). FOLFIRINOX lengthens overall survival time (OS), but no specific data are available in elderly patients. METHODS: All cases of inoperable pancreatic adenocarcinoma in patients over 70 years old treated with FOLFIRINOX were retrospectively reviewed between 2008 and 2015 in five institutions in France. The primary objective was to evaluate the safety and efficacy of FOLFIRINOX in the elderly...
December 24, 2016: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
https://www.readbyqxmd.com/read/28030797/galeterone-and-its-analogs-inhibit-mnk-eif4e-axis-synergize-with-gemcitabine-impede-pancreatic-cancer-cell-migration-invasion-and-proliferation-and-inhibit-tumor-growth-in-mice
#13
Andrew K Kwegyir-Afful, Francis N Murigi, Puranik Purushottamachar, Vidya P Ramamurthy, Marlena S Martin, Vincent C O Njar
Survival rate for pancreatic cancer (pancreatic ductal adenocarcinoma, PDAC) is poor, with about 80% of patients presenting with the metastatic disease. Gemcitabine, the standard chemotherapeutic agent for locally advanced and metastatic PDAC has limited efficacy, attributed to innate/acquired resistance and activation of pro-survival pathways. The Mnk1/2-eIF4E and NF-κB signaling pathways are implicated in PDAC disease progression/metastasis and also associated with gemcitabine-induced resistance in PDAC...
December 24, 2016: Oncotarget
https://www.readbyqxmd.com/read/28025817/cost-effectiveness-of-metal-stents-in-relieving-obstructive-jaundice-in-patients-with-pancreatic-cancer
#14
J M Martinez, A Anene, T G K Bentley, M J Cangelosi, L M Meckley, J D Ortendahl, A J Montero
BACKGROUND: ASGE and ESGE guidelines recommend endoscopic metal stent placement for pancreatic carcinoma patients with biliary obstruction, and whose estimated life expectancy is greater than 6 months. Because median overall survival (OS) of metastatic pancreatic adenocarcinoma until recently has been less than 6 months, plastic biliary stents were preferentially placed rather than metal due to the greater upfront cost of the latter. Recent advances in the treatment of metastatic pancreatic cancer have extended median OS beyond the 6-month range...
December 27, 2016: Journal of Gastrointestinal Cancer
https://www.readbyqxmd.com/read/28011497/gemcitabine-and-s-1-induction-chemotherapy-followed-by-chemoradiotherapy-for-locally-advanced-pancreatic-cancers
#15
Kosei Maemura, Yuko Mataki, Hiroshi Kurahara, Yota Kawasaki, Satoshi Iino, Masahiko Sakoda, Yasuto Uchikado, Takaaki Arigami, Yoshikazu Uenosono, Shinichiro Mori, Shinichi Ueno, Hiroyuki Shinchi, Shoji Natsugoe
BACKGROUND: Gemcitabine and S-1 are drugs commonly used for treating locally advanced pancreatic cancer (LAPC). However, the safety and efficacy of combination of these agents for induction chemotherapy (IC) followed by chemoradiotherapy are not well-defined. PATIENTS AND METHODS: Fifteen patients with LAPC (IC-CRT group) were treated with gemcitabine and S-1 IC, followed by S-1 chemoradiotherapy. The clinical outcomes were compared to a cohort of 38 patients who received chemoradiotherapy alone (CRT group)...
January 2017: Anticancer Research
https://www.readbyqxmd.com/read/28007080/preoperative-embolization-of-the-celiac-axis-or-common-hepatic-artery-before-distal-pancreatectomy-with-resection-of-the-celiac-axis
#16
Markus Zimmermann, Martin Liebl, Maximilian Schulze-Hagen, Federico Pedersoli, Jochen Pfeffer, Maximilian Schmeding, Peter Isfort, Christiane K Kuhl, Philipp Bruners
Patients with locally advanced pancreatic cancer who undergo distal pancreatectomy with resection of the celiac axis (CA) are at risk for postoperative hepatic or gastric ischemia if collateral blood flow from the superior mesenteric artery (SMA) via the gastroduodenal artery is insufficient. This study presents a technique for preoperative angiographic evaluation of these collateral vessels by using an AMPLATZER Vascular Plug to temporarily occlude the CA or common hepatic artery while simultaneously performing digital subtraction angiography of the SMA...
January 2017: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/27998964/phase-2-placebo-controlled-double-blind-trial-of-dasatinib-added-to-gemcitabine-for-patients-with-locally-advanced-pancreatic-cancer
#17
T R J Evans, E Van Cutsem, M J Moore, I S Bazin, A Rosemurgy, G Bodoky, G Deplanque, M Harrison, B Melichar, D Pezet, A Elekes, E Rock, C Lin, L Strauss, P J O'Dwyer
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) has a high mortality rate with limited treatment options. Gemcitabine provides a marginal survival benefit for patients with advanced PDAC. Dasatinib is a competitive inhibitor of Src kinase, which is overexpressed in PDAC tumors. Dasatinib and gemcitabine were combined in a phase 1 clinical trial where stable disease was achieved in 2 of 8 patients with gemcitabine-refractory PDAC. PATIENTS AND METHODS: This placebo-controlled, randomized, double-blind, phase II study compared the combination of gemcitabine plus dasatinib to gemcitabine plus placebo in patients with locally advanced, non-metastatic PDAC...
December 19, 2016: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/27993964/plasma-circulating-tumor-dna-in-pancreatic-cancer-patients-is-a-prognostic-marker
#18
Daniel Pietrasz, Nicolas Pécuchet, Fanny Garlan, Audrey Didelot, Olivier Dubreuil, Solène Doat, Francoise Imbert-Bismut, Mehdi Karoui, Jean-Christophe Vaillant, Valérie Taly, Pierre Laurent-Puig, Jean-Baptiste Bachet
PURPOSE: Despite recent therapeutic advances, prognosis of patients with pancreatic adenocarcinoma remains poor. Analyses from tumor tissues present limitations; identification of informative marker from blood might be a promising alternative. The aim of this study was to assess the feasibility and the prognostic value of circulating tumor DNA (ctDNA) in pancreatic adenocarcinoma. EXPERIMENTAL DESIGN: From 2011 to 2015, blood samples were prospectively collected from all consecutive patients with pancreatic adenocarcinoma treated in our center...
January 1, 2017: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/27967240/the-significance-of-the-prognostic-nutritional-index-for-all-stages-of-pancreatic-cancer
#19
Sang Hoon Lee, Moon Jae Chung, Bun Kim, Hee Seung Lee, Hyun Jik Lee, Ja Yoon Heo, Yeong Jin Kim, Jeong Youp Park, Seungmin Bang, Seung Woo Park, Si Young Song, Jae Bock Chung
Nutritional status affects the prognosis of various tumors. The prognostic nutritional index (PNI) is the known predictor of postoperative outcome in resectable pancreatic cancer patients. This study aimed to validate the prognostic value of PNI in all stages of pancreatic cancer. We retrospectively reviewed 499 patients with pancreatic cancer who were diagnosed at Severance Hospital between January 2006 and December 2011. The PNI value was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (/mm(3)) at initial diagnosis...
December 14, 2016: Nutrition and Cancer
https://www.readbyqxmd.com/read/27958223/a-single-institution-experience-with-open-irreversible-electroporation-for-locally-advanced-pancreatic-carcinoma
#20
Li Yan, Yong-Liang Chen, Ming Su, Tian Liu, Kai Xu, Feng Liang, Wan-Qing Gu, Shi-Chun Lu
BACKGROUND: Locally advanced pancreatic carcinoma (LAPC) is characterized by poor prognosis despite recommended concurrent chemoradiotherapy. Irreversible electroporation (IRE) has emerged as a potential option for the management of unresectable pancreatic cancer. This study was conducted to evaluate the safety and short-term efficacy of open IRE for the treatment of LAPC. METHODS: Retrospective data of 25 consecutive patients receiving IRE for T3 lesions from July 2015 to June 2016 at a single center were analyzed...
2016: Chinese Medical Journal
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