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Locally advanced pancreatic cancer

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https://www.readbyqxmd.com/read/27909037/safety-and-efficacy-of-stereotactic-body-radiation-therapy-combined-with-s-1-simultaneously-followed-by-sequential-s-1-as-an-initial-treatment-for-locally-advanced-pancreatic-cancer-silapanc-trial-study-design-and-rationale-of-a-phase-ii-clinical-trial
#1
Xiaofei Zhu, Xiaoping Ju, Fei Cao, Fang Fang, Shuiwang Qing, Yuxin Shen, Zhen Jia, Yangsen Cao, Huojun Zhang
INTRODUCTION: Upfront surgeries are not beneficial to most patients with pancreatic cancer. Therefore, more emphasis has been placed chemoradiotherapy in locally advanced pancreatic cancer recently. Gemcitabine-based regimens or FOLFIRINOX (a chemotherapy regimen including leucovorin, 5-FU, irinotecan, oxaliplatin) has been proven as a standard chemotherapy in pancreatic cancer. However, severe toxicities may prevent the completion of chemotherapy. S-1 has showed better objective response rates, similar overall survival rates and progression-free survival rates compared with gemcitabine, revealing that S-1 may be a potential candidate in treating pancreatic cancer, especially for patients refractory to gemcitabine...
December 1, 2016: BMJ Open
https://www.readbyqxmd.com/read/27905367/-celiac-trunk-resection-in-patients-with-pancreatic-cancer-and-severe-pain-syndrome
#2
Yu I Patyutko, M G Abgaryan, N E Kudashkin, A G Kotel'nikov
AIM: To show the advisability, satisfactory tolerance and good analgesic effect of surgery for pancreatic ductal carcinoma with celiac trunk invasion. MATERIAL AND METHODS: Distal subtotal pancreatectomy with resection of celiac trunk and common hepatic artery was made in 21 patients. RESULTS: Early postoperative complications after distal subtotal pancreatectomy with celiac trunk resection occurred in 10 (47.6%) patients. There was no postoperative mortality...
2016: Khirurgiia
https://www.readbyqxmd.com/read/27904860/interventional-therapy-for-pancreatic-cancer
#3
REVIEW
Jianwei Zhu, Zhendong Jin
BACKGROUND: Palliative therapy and primarily chemoradiotherapy are the mainstream treatments in patients with locally advanced or metastatic pancreatic cancer (PC). Conventional endoscopy and endoscopic ultrasound (EUS)-guided interventional therapy has emerged as an important procedure for PC management. In this review, the progress in conventional endoscopy and EUS for PC management is discussed. SUMMARY: For local palliative therapy against PC, EUS-guided fine needle injection (FNI) could deliver different kinds of agents, such as radioactive seeds and fiducials...
October 2016: Gastrointestinal Tumors
https://www.readbyqxmd.com/read/27896518/analysis-of-predictors-of-resection-and-survival-in-locally-advanced-stage-iii-pancreatic-cancer-does-the-nature-of-chemotherapy-regimen-influence-outcomes
#4
Filip Bednar, Mazen S Zenati, Jennifer Steve, Sharon Winters, Lee M Ocuin, Nathan Bahary, Melissa E Hogg, Herbert J Zeh, Amer H Zureikat
BACKGROUND: Locally advanced unresectable pancreatic cancer (LAPC) historically portends a poor prognosis. FOLFIRINOX and gemcitabine/nab-paclitaxel have proven effective in the metastatic setting. We sought to evaluate the outcomes of these regimens compared with older regimens in LAPC. METHODS: A retrospective, single institutional review of all consecutive LAPC treated with "new" (FOLFIRINOX and/or gemcitabine/nab-paclitaxel) and "old" (gemcitabine or 5-FU) chemotherapy from 2010 to 2014 was performed...
November 28, 2016: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/27896469/ct-evaluation-after-neoadjuvant-folfirinox-chemotherapy-for-borderline-and-locally-advanced-pancreatic-adenocarcinoma
#5
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/27895816/clinical-impact-of-chemotherapy-to-improve-tumor-microenvironment-of-pancreatic-cancer
#6
REVIEW
Takahiro Tsuchikawa, Shintaro Takeuchi, Toru Nakamura, Toshiaki Shichinohe, Satoshi Hirano
A perioperative multimodal strategy including combination chemotherapy and radiotherapy, in addition to surgical resection, has been acknowledged to improve patient prognosis. However chemotherapy has not been actively applied as an immunomodulating modality because of concerns about various immunosuppressive effects. It has recently been shown that certain chemotherapeutic agents could modify tumor microenvironment and host immune responses through several underlying mechanisms such as immunogenic cell death, local T-cell infiltration and also the eradication of immune-suppressing regulatory cells such as regulatory T cells (Tregs) and myeloid-derived suppressor cells...
November 15, 2016: World Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/27893715/tgf%C3%AE-promotes-mesenchymal-phenotype-of-pancreatic-cancer-cells-in-part-through-epigenetic-activation-of-vav1
#7
P-H Huang, P-J Lu, L-Y Ding, P-C Chu, W-Y Hsu, C-S Chen, C-C Tsao, B-H Chen, C-T Lee, Y-S Shan, C-S Chen
The highly homeostasis-resistant nature of cancer cells leads to their escape from treatment and to liver metastasis, which in turn makes pancreatic ductal adenocarcinoma (PDAC) difficult to treat, especially the squamous/epithelial-to-mesenchymal transition (EMT)-like subtype. As the molecular mechanisms underlying tumour heterogeneity remain elusive, we investigated whether epigenetic regulation might explain inter-individual differences in the progression of specific subtypes. DNA methylation profiling performed on cancer tissues prior to chemo/radiotherapy identified one hypermethylated CpG site (CpG6882469) in the VAV1 gene body that was correlated with demethylation of two promoter CpGs (CpG6772370/CpG6772811) in both PDAC and peripheral blood...
November 28, 2016: Oncogene
https://www.readbyqxmd.com/read/27889543/eus-guided-fine-needle-injection-of-gemcitabine-for-locally-advanced-and-metastatic-pancreatic-cancer
#8
Michael J Levy, Steven R Alberts, William R Bamlet, Patrick A Burch, Michael B Farnell, Ferga C Gleeson, Michael G Haddock, Michael L Kendrick, Ann L Oberg, Gloria M Petersen, Naoki Takahashi, Suresh T Chari
BACKGROUND & AIMS: Among the greatest hurdles to pancreatic cancer (PC) therapy is the limited tissue penetration of systemic chemotherapy due to tumor desmoplasia. The primary study aim was to determine the toxicity profile of EUS-guided fine-needle injection (EUS-FNI) with gemcitabine. Secondary endpoints included ability to disease downstage leading to a R0 resection, and overall survival at 6 months, 12 months, and 5 years after therapy. PATIENTS AND METHODS: In a prospective study from a tertiary referral center, gemcitabine (38mg/ml) EUS-FNI was performed in PC patients before conventional therapy...
November 23, 2016: Gastrointestinal Endoscopy
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
#9
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
#10
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/27867166/the-usefulness-of-using-fiducial-marker-in-proton-therapy-for-locally-advanced-pancreatic-cancer
#11
Masakazu Shimizu, Takahiro Sato, Yoshihide Sawa, Kazuki Terashima, Toshihiro Yanou, Ryoji Ida
BACKGROUND: Though the dosimetric criteria for the gastrointestinal tract were met, late gastrointestinal toxicity was seen in several cases. Therefore, we thought that it was caused by the positional variation of gastrointestine surrounding pancreatic cancer because of peristalsis. METHOD: They were confirmed by CT image regularly. And we evaluated that how much the difference of matching methods for correcting the positional variation influenced dose distribution...
2016: Nihon Hoshasen Gijutsu Gakkai Zasshi
https://www.readbyqxmd.com/read/27865285/palliative-care-for-pancreatic-and-periampullary-cancer
#12
REVIEW
Jennifer A Perone, Taylor S Riall, Kelly Olino
Most patients with pancreatic cancer will present with metastatic or locally advanced disease. Unfortunately, most patients with localized disease will experience recurrence even after multimodality therapy. As such, pancreatic cancer patients arrive at a common endpoint where decisions pertaining to palliative care come to the forefront. This article summarizes surgical, endoscopic, and other palliative techniques for relief of obstructive jaundice, relief of duodenal or gastric outlet obstruction, and relief of pain due to invasion of the celiac plexus...
December 2016: Surgical Clinics of North America
https://www.readbyqxmd.com/read/27865283/management-of-locally-advanced-pancreatic-cancer
#13
REVIEW
Robert C G Martin
The diagnosis for locally advanced pancreatic cancer is based on high-quality cross-sectional imaging, which shows tumor invasion into the celiac/superior mesenteric arteries and/or superior mesenteric/portal venous system that is not reconstructable. The optimal management of these patients is evolving quickly with the advent of newer chemotherapeutics, radiation, and nonthermal ablation modalities. This article presents the current status of initial chemotherapy, surgical therapy, ablative therapy, and radiation therapy for patients with nonmetastatic locally advanced unresectable pancreatic cancer...
December 2016: Surgical Clinics of North America
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
#14
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
#15
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/27858118/utility-of-amplatzer-vascular-plug-with-preoperative-common-hepatic-artery-embolization-for-distal-pancreatectomy-with-en-bloc-celiac-axis-resection
#16
Masafumi Toguchi, Masakatsu Tsurusaki, Isao Numoto, Syojiro Hidaka, Miho Yamakawa, Nobuyuki Asato, SungWoon Im, Yukinobu Yagyu, Mitsuru Matsuki, Yoshifumi Takeyama, Takamichi Murakami
PURPOSE: To evaluate the feasibility and safety of the Amplatzer vascular plug (AVP) for preoperative common hepatic embolization (CHA) before distal pancreatectomy with en bloc celiac axis resection (DP-CAR) to redistribute blood flow to the stomach and liver via the superior mesenteric artery (SMA). MATERIALS AND METHODS: Four patients (3 males, 1 female; median age 69 years) with locally advanced pancreatic body cancer underwent preoperative CHA embolization with AVP...
November 17, 2016: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/27857025/efficacy-of-chemotherapy-in-patients-with-unresectable-or-metastatic-pancreatic-acinar-cell-carcinoma-potentially-improved-efficacy-with-oxaliplatin-containing-regimen
#17
Changhoon Yoo, Bum Jun Kim, Kyu-Pyo Kim, Jae-Lyun Lee, Tae Won Kim, Baek-Yeol Ryoo, Heung-Moon Chang
Purpose: Pancreatic acinar cell carcinoma (ACC) is a rare cancer of the exocrine pancreas. Because of its rare incidence, the efficacy of chemotherapy in this patient population has been largely unknown. Therefore, we retrospectively analyzed the outcomes of patients with advanced pancreatic ACC who received chemotherapy. Materials and Methods: Between January 1997 and March 2015, 15 patients with unresectable or metastatic pancreatic ACC who received systemic chemotherapy were identified in Asan Medical Center, Korea...
November 9, 2016: Cancer Research and Treatment: Official Journal of Korean Cancer Association
https://www.readbyqxmd.com/read/27856215/irreversible-electroporation-for-locally-advanced-pancreatic-cancer
#18
J-P Tasu, G Vesselle, G Herpe, J-P Richer, S Boucecbi, S Vélasco, M Carretier, B Debeane, D Tougeron
Pancreatic adenocarcinoma is one of the solid cancers associated with the poorest prognosis; the only curative treatment remains surgical resection but in most cases, this treatment is not possible because of distant metastasis or local extension. Irreversible electroporation is a new tumor ablation technique, which provides cellular apoptosis without any thermal coagulation effect. This technique helps preserve the ducts, vessels or nerves located in the treatment area. This article reviews the current knowledge regarding the use of electroporation for the treatment of pancreatic adenocarcinoma...
December 2016: Diagnostic and Interventional Imaging
https://www.readbyqxmd.com/read/27826200/a-current-perspective-on-stereotactic-body-radiation-therapy-for-pancreatic-cancer
#19
REVIEW
Julian C Hong, Brian G Czito, Christopher G Willett, Manisha Palta
Pancreatic cancer is a formidable malignancy with poor outcomes. The majority of patients are unable to undergo resection, which remains the only potentially curative treatment option. The management of locally advanced (unresectable) pancreatic cancer is controversial; however, treatment with either chemotherapy or chemoradiation is associated with high rates of local tumor progression and metastases development, resulting in low survival rates. An emerging local modality is stereotactic body radiation therapy (SBRT), which uses image-guided, conformal, high-dose radiation...
2016: OncoTargets and Therapy
https://www.readbyqxmd.com/read/27811354/is-chronic-hepatitis-b-infection-a-protective-factor-for-the-progression-of-advanced-pancreatic-ductal-adenocarcinoma-an-analysis-from-a-large-multicenter-cohort-study
#20
Qiwen Chen, Zhouyu Ning, Lei Wang, Haifeng Ying, Shu Dong, Chenyue Zhang, Xiaoheng Shen, Yuanbiao Guo, Hao Chen, Xiaoyan Zhu, Yehua Shen, Weidong Shi, Yongqiang Hua, Kun Wang, Junhua Lin, Litao Xu, Lianyu Chen, Lanyun Feng, Xiumei Zhang, Jing Xie, Bo Sun, Yaqin Sun, Wenchao Gu, Mei Kang, Zheng Tang, Zhujun Chen, Zhen Chen, Luming Liu, Jinming Yu, Zhaoshen Li, Zhiqiang Meng
PURPOSE: Whether the progression of advanced pancreatic ductal adenocarcinoma (PDAC) patients could be affected by HBV exposure remains to be determined. Therefore, we conducted this study to assess the effect of HBV infection on PDAC progression among a large cohort in China. METHODS: A multicenter cohort study was conducted to explore whether liver metastasis and overall survival in locally advanced and metastatic PDAC could be affected by HBV infection. In this study, we collected 1,526 advanced PDAC patients at three participating hospitals - Shanghai Cancer Center, Changhai Hospital and Ruijin Hospital from 2004 to 2013...
November 1, 2016: Oncotarget
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