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Locally advanced pancreatic cancer

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https://www.readbyqxmd.com/read/29782352/an-update-on-the-management-of-pancreatic-neuroendocrine-tumors
#1
Limin Gao, Nikola S Natov, Kevin P Daly, Faisal Masud, Sadia Chaudhry, Mark J Sterling, Muhammad W Saif
Pancreatic neuroendocrine tumors (PNETs) are a rare and heterogeneous group of neoplasia and differ in their clinical presentation, behavior, and prognosis based on both histological features and cancer stage at the time of diagnosis. Although small-sized tumors can be surgically resected, locally advanced and metastatic tumors confer a poor prognosis. In addition, only limited treatment options are available to the latter group of patients with PNETs, such as hormonal analogs, cytotoxic agents, and targeted therapy...
May 8, 2018: Anti-cancer Drugs
https://www.readbyqxmd.com/read/29777302/emerging-strategies-in-brca-positive-pancreatic-cancer
#2
REVIEW
Adam Kowalewski, Łukasz Szylberg, Michał Saganek, Wojciech Napiontek, Paulina Antosik, Dariusz Grzanka
PURPOSE: We propose a treatment algorithm for PDAC with particular emphasis on BRCA1 or 2 mutation-positive patients. Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest diseases in the United States and Europe. BRCA1 and BRCA2 are among the most common of the known genetic mutations involved in familial PDAC. The optimal chemotherapy regimen to use for BRCA1 or 2 mutation carriers with PDAC is not yet established. As new treatment options emerge, algorithms must balance the need to give the best drugs first with ensuring that there are still beneficial options available for later...
May 18, 2018: Journal of Cancer Research and Clinical Oncology
https://www.readbyqxmd.com/read/29774075/plectin-targeted-liposomes-enhance-the-therapeutic-efficacy-of-a-parp-inhibitor-in-the-treatment-of-ovarian-cancer
#3
Siva Sai Krishna Dasa, Galina Diakova, Ryo Suzuki, Anne M Mills, Michael F Gutknecht, Alexander L Klibanov, Jill K Slack-Davis, Kimberly A Kelly
Advances in genomics and proteomics drive precision medicine by providing actionable genetic alterations and molecularly targeted therapies, respectively. While genomic analysis and medicinal chemistry have advanced patient stratification with treatments tailored to the genetic profile of a patient's tumor, proteomic targeting has the potential to enhance the therapeutic index of drugs like poly(ADP-ribose) polymerase (PARP) inhibitors. PARP inhibitors in breast and ovarian cancer patients with BRCA1/2 mutations have shown promise...
2018: Theranostics
https://www.readbyqxmd.com/read/29773761/surgical-treatment-of-pancreatic-cancer
#4
Wioletta Masiak-Segit, Karol Rawicz-Pruszyński, Magdalena Skórzewska, Wojciech P Polkowski
The only way to cure the patient with adenocarcinoma of the pancreas (RT) is surgical excision of the tumor. The standard surgical treatment of resectable pancreatic carcinoma is considered the classic pancreatoduodenectomy (PD) with the Kausch- Whipple procedure, or the pylorus-preserving PD with the Traverso-Longmire method. The most difficult technically and at the same time the most important PD stage from an oncological point of view is the separation of the head of the pancreas from the superior mesenteric artery...
April 30, 2018: Polski Przeglad Chirurgiczny
https://www.readbyqxmd.com/read/29771005/prospective-analysis-of-different-combined-regimens-of-stereotactic-body-radiation-therapy-and-chemotherapy-for-locally-advanced-pancreatic-cancer
#5
Xiaofei Zhu, Dongchen Shi, Fuqi Li, Xiaoping Ju, Yangsen Cao, Yuxin Shen, Fei Cao, Shuiwang Qing, Fang Fang, Zhen Jia, Huojun Zhang
To identify impacts of different combined regimens of stereotactic body radiation therapy (SBRT) and chemotherapy on survival of patients with locally advanced pancreatic cancer (LAPC) and factors correlated with determinations of different combinations. Four hundred and nineteen patients with radiographically and biopsy-proven LAPC were prospectively enrolled. Factors associated with different strategies were analyzed with Chi-square test and contingency coefficients. Cox regression was used to identify factors predictive of survival...
May 17, 2018: Cancer Medicine
https://www.readbyqxmd.com/read/29768067/the-development-of-fluorescence-guided-surgery-for-pancreatic-cancer-from-bench-to-clinic
#6
Thinzar M Lwin, Robert M Hoffman, Michael Bouvet
Surgeons face major challenges in achieving curative R0 resection for pancreatic cancers. When the lesion is localized, they must appropriately visualize the tumor, determine appropriate resection margins, and ensure complete tumor clearance. Real-time surgical navigation using fluorescence-guidance has enhanced the ability of surgeons to see the tumor and has the potential to assist in achieving more oncologically-complete resections. When there is metastatic disease, fluorescence enhancement can help detect these lesions and prevent unnecessary and futile surgeries...
May 16, 2018: Expert Review of Anticancer Therapy
https://www.readbyqxmd.com/read/29765792/stereotactic-mri-guided-adaptive-radiation-therapy-smart-for-locally-advanced-pancreatic-cancer-a-promising-approach
#7
Elaine Luterstein, Minsong Cao, James Lamb, Ann C Raldow, Daniel A Low, Michael L Steinberg, Percy Lee
Locally advanced pancreatic cancer (LAPC) is characterized by poor prognosis and low response durability with standard-of-care chemotherapy or chemoradiotherapy treatment. Stereotactic body radiation therapy (SBRT), which has a shorter treatment course than conventionally fractionated radiotherapy and allows for better integration with systemic therapy, may confer a survival benefit but is limited by gastrointestinal toxicity. Stereotactic MRI-guided adaptive radiation therapy (SMART) has recently gained attention for its potential to increase treatment precision and thus minimize this toxicity through continuous real-time soft-tissue imaging during radiotherapy...
March 14, 2018: Curēus
https://www.readbyqxmd.com/read/29765563/targeted-therapies-in-the-management-of-locally-advanced-and-metastatic-pancreatic-cancer-a-systematic-review
#8
REVIEW
Anjali V Sheahan, Andrew V Biankin, Christopher R Parish, Levon M Khachigian
Pancreatic cancer has a dismal prognosis particularly in patients presenting with unresectable tumors. We performed a bibliometric analysis of clinical trials for pancreatic cancer conducted between 2014-2016 focusing on patients that presented with unresectable (locally advanced or metastatic) tumors. We discuss a range of studies that employed FOLFIRINOX, the gemcitabine + nab-paclitaxel combination and studies that used molecularly-targeted therapy. Major areas of focus have been dual targeting of EGFR and VEGFR, immunotherapy or a multimodal approach - combining chemotherapy with radiotherapy...
April 20, 2018: Oncotarget
https://www.readbyqxmd.com/read/29755782/folfirinox-treatment-leading-to-pathologic-complete-response-of-a-locally-advanced-pancreatic-cancer
#9
Andreas Minh Luu, Torsten Herzog, Philipp Hoehn, Anke Reinacher-Schick, Johanna Munding, Waldemar Uhl, Chris Braumann
Pancreatic cancer (PC) is a lethal disease with a poor prognosis. It is typically asymptomatic and therefore most often diagnosed at an advanced stage. A primary unresectable PC can become resectable in case of tumor regression turning palliative into neoadjuvant therapy. We present a 67-year old female patient who was diagnosed with a locally advanced adenocarcinoma of the pancreatic head. After receiving palliative intended chemotherapy with the FOLFIRINOX regimen, staging computed tomography revealed local resectability of the pancreatic head tumor...
April 2018: Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/29721211/advanced-pancreatic-cancer-a-meta-analysis-of-clinical-trials-over-thirty-years
#10
Bradley R Hall, Andrew Cannon, Pranita Atri, Christopher S Wichman, Lynette M Smith, Apar K Ganti, Chandrakanth Are, Aaron R Sasson, Sushil Kumar, Surinder K Batra
Background: In contrast to other cancers, survival rates for pancreatic ductal adenocarcinoma (PDAC) patients have improved but minimally over the past thirty years. The aim of this study was to perform a meta-analysis of clinical trials published since 1986 to determine trends in median overall survival in primarily metastatic PDAC. Materials and methods: All Phase 2-4 clinical trials published during or after 1986 investigating first-line systemic chemotherapy in metastatic PDAC were included in the meta-analysis...
April 10, 2018: Oncotarget
https://www.readbyqxmd.com/read/29717230/therapeutic-developments-in-pancreatic-cancer-current-and-future-perspectives
#11
REVIEW
John P Neoptolemos, Jörg Kleeff, Patrick Michl, Eithne Costello, William Greenhalf, Daniel H Palmer
The overall 5-year survival for pancreatic cancer has changed little over the past few decades, and pancreatic cancer is predicted to be the second leading cause of cancer-related mortality in the next decade in Western countries. The past few years, however, have seen improvements in first-line and second-line palliative therapies and considerable progress in increasing survival with adjuvant treatment. The use of biomarkers to help define treatment and the potential of neoadjuvant therapies also offer opportunities to improve outcomes...
May 1, 2018: Nature Reviews. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29696321/linac-based-stereotactic-body-radiation-therapy-for-unresectable-locally-advanced-pancreatic-cancer-risk-adapted-dose-prescription-and-image-guided-delivery
#12
Rosario Mazzola, Sergio Fersino, Dario Aiello, Fabiana Gregucci, Umberto Tebano, Stefanie Corradini, Gioacchino Di Paola, Massimo Cirillo, Luca Tondulli, Giacomo Ruffo, Ruggero Ruggieri, Filippo Alongi
BACKGROUND: Stereotactic body radiation therapy (SBRT) represents a new treatment option for locally advanced pancreatic cancer (LAPC). An accurate treatment planning with risk-adapted dose prescription with adherence to specific dose constraints for organs at risk (OARs) and the use of daily cone beam CT (CBCT) for image guidance could allow an effective and safe treatment delivery. Here, feasibility and efficacy of SBRT in LAPC treated in our cancer care center are reported. PATIENTS AND METHODS: 33 unresectable LAPC patients underwent SBRT...
April 25, 2018: Strahlentherapie und Onkologie: Organ der Deutschen Röntgengesellschaft ... [et Al]
https://www.readbyqxmd.com/read/29685381/an-onco-geriatric-approach-to-select-older-patients-for-optimal-treatments-of-pancreatic-adenocarcinoma
#13
Elisabeth Castel-Kremer, Solene De Talhouet, Anne-Laure Charlois, Emmanuelle Graillot, Xavier Chopin-Laly, Mustapha Adham, Brigitte Comte, Catherine Lombard-Bohas, Thomas Walter, Gilles Boschetti
INTRODUCTION: Pancreatic adenocarcinoma affects mainly older patients. Surgery is indicated for localized tumors while chemotherapy alone is proposed in advanced or metastatic tumors. OBJECTIVE: To evaluate the feasibility of standard of care oncologic treatments in this population, the accuracy of the geriatric evaluation to predict the ability of patients to tolerate the recommended treatments and to identify specific geriatric prognosis factors. METHODS: We included, between 2007 and 2014, all consecutive patients over 70 years of age with a pathologically diagnosed pancreatic cancer...
April 20, 2018: Journal of Geriatric Oncology
https://www.readbyqxmd.com/read/29683973/nationwide-multicenter-observational-study-of-folfirinox-chemotherapy-in-399-patients-with-unresectable-or-recurrent-pancreatic-cancer-in-japan
#14
Akiko Todaka, Nobumasa Mizuno, Masato Ozaka, Hideki Ueno, Satoshi Kobayashi, Kazuhiro Uesugi, Noritoshi Kobayashi, Hideyuki Hayashi, Kentaro Sudo, Naohiro Okano, Yosuke Horita, Keiko Kamei, Seigo Yukisawa, Shoji Nakamori, Yutaka Yachi, Toshiyuki Henmi, Marina Kobayashi, Narikazu Boku, Keita Mori, Akira Fukutomi
OBJECTIVES: FOLFIRINOX (oxaliplatin, irinotecan, 5-fluorouracil, and leucovorin) is the standard therapy worldwide for unresectable pancreatic cancer; however, clinical data for Japanese patients are limited. Therefore, the observational study of FOLFIRINOX for patients with pancreatic cancer was conducted. METHODS: The study included 399 patients with unresectable or recurrent pancreatic cancer, from 27 institutions in Japan, treated with FOLFIRINOX and surveyed until December 2015...
May 2018: Pancreas
https://www.readbyqxmd.com/read/29680448/the-role-of-intraoperative-radiotherapy-iort-in-the-management-of-patients-with-pancreatic-and-periampullary-cancer-a-single-center-experience
#15
Ayman Zaki Azzam, Ahmed Alqarni, Tarek Mahmoud Amin
BACKGROUND: In spite of the advances in modern surgery, the outcome for patients suffering from pancreatic adenocarcinoma or periampullary adenocarcinoma is still bad. Recently, introperative radiotherapy (IORT) was introduced into the multimodality management approach to improve both tumor control and patient' survival. AIM OF WORK: To evaluate our initial experience in combined surgical resection and IORT, and to evaluate the feasibility of the application of IORT and its effect on morbidity, mortality and local recurrence...
April 18, 2018: Journal of the Egyptian National Cancer Institute
https://www.readbyqxmd.com/read/29679211/surgery-after-folfirinox-treatment-for-locally-advanced-and-borderline-resectable-pancreatic-cancer-increase-in-tumour-attenuation-on-ct-correlates-with-r0-resection
#16
Giovanni Marchegiani, Valentina Todaro, Enrico Boninsegna, Riccardo Negrelli, Binit Sureka, Debora Bonamini, Roberto Salvia, Riccardo Manfredi, Roberto Pozzi Mucelli, Claudio Bassi
OBJECTIVES: To assess factors associated with radical resection (R0) of pancreatic ductal adenocarcinoma (PDAC) after induction treatment with FOLFIRINOX. METHODS: Patients with either locally advanced (LA) and borderline resectable (BR) PDAC undergoing surgical exploration after FOLFIRINOX were retrospectively enrolled. Two pancreatic radiologists reviewed the CT blinded to the final outcome and assessed chemotherapy response and resectability. Patients were then divided into R0 resected (group A) and not resected/R1 resected (group B), which were compared...
April 20, 2018: European Radiology
https://www.readbyqxmd.com/read/29665583/clinical-effectiveness-and-potential-survival-benefit-of-us-guided-high-intensity-focused-ultrasound-therapy-in-patients-with-advanced-stage-pancreatic-cancer
#17
Milka Marinova, Hannah C Huxold, Jana Henseler, Martin Mücke, Rupert Conrad, Roman Rolke, Hojjat Ahmadzadehfar, Maximilian Rauch, Rolf Fimmers, Guido Luechters, Henning Cuhls, Lukas Radbruch, Hans H Schild, Holger Strunk
PURPOSE:  Pancreatic cancer (PaC) is a life-limiting tumor with a wide range of incapacitating symptoms such as cancer pain in more than 80 % of patients. This prospective interventional study addresses the clinical effectiveness of ultrasound-guided high-intensity focused ultrasound (HIFU) treatment for patients with advanced-stage PaC, including pain perception, tumor size and survival benefit. MATERIALS AND METHODS:  50 patients with late-stage PaC underwent HIFU...
April 17, 2018: Ultraschall in der Medizin
https://www.readbyqxmd.com/read/29651809/development-of-chemotherapy-and-significance-of-conversion-surgery-after-chemotherapy-in-unresectable-pancreatic-cancer
#18
REVIEW
Junji Furuse, Junji Shibahara, Masanori Sugiyama
While surgery currently remains the only potentially curative treatment available for pancreatic cancer, only 20% to 30% of patients have resectable disease at diagnosis. Recently, with the introduction of intensive chemotherapy regimens such as oxaliplatin, irinotecan, fluorouracil plus leucovorin (FOLFIRINOX) and gemcitabine plus nab-paclitaxel, for the treatment of unresectable pancreatic cancer, the antitumor activity and overall survival in patients with pancreatic cancer have dramatically improved. These advances in intensive chemotherapy have led to the possibility of conversion of unresectable disease to resectable disease, and it has been reported that more than 20% of pancreatic cancer patients with unresectable locally advanced disease at diagnosis undergo successful conversion surgery after FOLFIRINOX therapy...
May 2018: Journal of Hepato-biliary-pancreatic Sciences
https://www.readbyqxmd.com/read/29650931/-a-case-of-locally-advanced-pancreatic-cancer-successfully-resected-after-s-1-therapy-in-an-elderly-patient
#19
Shojirokazunori Ikenaga, Masaaki Endo, Masahiro Iwama, Motonari Ohashi, Makoto Yokoyama, Hiroyuki Jin, Tomomi Kusumi
We report a case of locally advanced pancreatic body cancer, accomplishing R0 resection following preoperative chemotherapy. An 80-year-old female patient was admitted to our hospital because of high CA19-9 levels.Based on computed tomography images, she was diagnosed with locally advanced cancer of the pancreatic body.We started S-1 chemotherapy (100mg/day, 2 weeks administration 1 week rest)because the tumor was suspected to have invaded the celiac trunk and the common hepatic artery.The tumor decreased in size, and the encasement of the celiac trunk and the common hepatic artery were released, following 6 months of chemotherapy...
March 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29649825/the-role-of-staging-laparoscopy-in-resectable-and-borderline-resectable-pancreatic-cancer-a-systematic-review-and-meta-analysis
#20
Robert Ta, Donal B O'Connor, Andrew Sulistijo, Benjamin Chung, Kevin C Conlon
AIM: The study aimed to determine the additional value of staging laparoscopy in patients with pancreatic cancer deemed potentially resectable based on computed tomography imaging. METHODS: A systematic literature search was performed using MEDLINE and the Cochrane Register of Controlled Trials (January 1995 to June 2017). Primary outcome measures were the overall yield and sensitivity to detect non-resectable disease. Quality of studies was assessed with the Newcastle-Ottawa Scale...
April 12, 2018: Digestive Surgery
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