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Borderline resectable pancreatic cancer

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https://www.readbyqxmd.com/read/29334562/is-a-pathological-complete-response-following-neoadjuvant-chemoradiation-associated-with-prolonged-survival-in-patients-with-pancreatic-cancer
#1
Jin He, Alex B Blair, Vincent P Groot, Ammar A Javed, Richard A Burkhart, Georgios Gemenetzis, Ralph H Hruban, Kevin M Waters, Justin Poling, Lei Zheng, Daniel Laheru, Joseph M Herman, Martin A Makary, Matthew J Weiss, John L Cameron, Christopher L Wolfgang
OBJECTIVES: To describe the survival outcome of patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma (BR/LA-PDAC) who have a pathologic complete response (pCR) following neoadjuvant chemoradiation. BACKGROUND: Patients with BR/LA-PDAC are often treated with neoadjuvant chemoradiation in an attempt to downstage the tumor. Uncommonly, a pCR may result. METHODS: A retrospective review of a prospectively maintained database was performed at a single institution...
January 12, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29290916/neoadjuvant-therapy-for-resectable-pancreatic-cancer
#2
REVIEW
Sheikh Hasibur Rahman, Robin Urquhart, Michele Molinari
The use of neoadjuvant therapies has played a major role for borderline resectable and locally advanced pancreatic cancers (PCs). For this group of patients, preoperative chemotherapy or chemoradiation has increased the likelihood of surgery with negative resection margins and overall survival. On the other hand, for patients with resectable PC, the main rationale for neoadjuvant therapy is that the overall survival with current strategies is unsatisfactory. There is a consensus that we need new treatments to improve the overall survival and quality of life of patients with PC...
December 15, 2017: World Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/29285651/a-long-term-survival-case-treated-with-conversion-surgery-following-chemotherapy-after-diagnostic-metastasectomy-for-pancreatic-cancer-with-synchronous-liver-metastasis
#3
Mitsuhiro Shimura, Masamichi Mizuma, Hiroki Hayashi, Akiko Mori, Tomoyoshi Tachibana, Tatsuo Hata, Masahiro Iseki, Tatsuyuki Takadate, Kyohei Ariake, Shimpei Maeda, Hideo Ohtsuka, Naoaki Sakata, Takanori Morikawa, Kei Nakagawa, Takeshi Naitoh, Takashi Kamei, Fuyuhiko Motoi, Michiaki Unno
BACKGROUND: Pancreatic cancer with distant metastases is classified as "unresectable," for which the standard treatment is systemic chemotherapy. The effectiveness of radical resection for pancreatic cancer with distant metastases is unknown. Here, we report a case of long term survival treated with conversion surgery following chemotherapy after diagnostic metastasectomy for pancreatic cancer with synchronous liver metastasis. CASE PRESENTATION: A 73-year-old man was referred to our hospital to examine and treat for cancer of the pancreatic body...
December 29, 2017: Surgical Case Reports
https://www.readbyqxmd.com/read/29285600/medical-oncology-and-pancreatic-cancer-what-the-radiologist-needs-to-know
#4
David R Fogelman, Gauri Varadhachary
The majority of PCs present as advanced disease, and treatment goals are for prolongation of life and palliation of the symptoms. Oncologists rely on our radiology colleagues to provide information on the extent of disease and the effectiveness of our treatment. The stakes rise in those patients where the disease has seemingly not spread and who might be treated with a goal of cure. For this subset of patients, medical oncologists and surgeons require as precise a radiologic description as possible in order to most accurately characterize the extent of the disease, in turn informing us as to the likelihood of a successful surgery and potential cure...
December 28, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/29274720/clinical-significance-of-defining-borderline-resectable-pancreatic-cancer
#5
REVIEW
Mee Joo Kang, Jin-Young Jang, Wooil Kwon, Sun-Whe Kim
Since the introduction of the concept of borderline resectable pancreatic cancer (BRPC), various definitions of this disease entity have been suggested. However, there are several obstacles in defining this disease category. The current diagnostic criteria of BRPC mainly focuses on its expanded 'technical resectability'; however, they are difficult to interpret because of their ambiguity using potential subjective or arbitrary terminology, In addition, limitations in current imaging technology and a lack of evidence in radiological-pathological-clinical correlation make it difficult to refine the criteria...
December 9, 2017: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
https://www.readbyqxmd.com/read/29241394/neoadjuvant-therapy-offers-longer-survival-than-upfront-surgery-for-poorly-differentiated-and-higher-stage-pancreatic-cancer
#6
Anna Nurmi, Harri Mustonen, Helka Parviainen, Katriina Peltola, Caj Haglund, Hanna Seppänen
BACKGROUND: Neoadjuvant therapy for pancreatic cancer remains controversial. Our aim was to assess differences in survival, disease recurrence and histopathological tumor characteristics between patients treated with neoadjuvant therapy followed by subsequent surgery and patients undergoing upfront surgery. MATERIAL AND METHODS: Out of 399 consecutive pancreatic ductal adenocarcinoma (PDAC) patients operated at Helsinki University Hospital in 2000-2015, 75 borderline resectable patients were treated with neoadjuvant therapy...
December 15, 2017: Acta Oncologica
https://www.readbyqxmd.com/read/29227344/predictors-of-resectability-and-survival-in-patients-with-borderline-and-locally-advanced-pancreatic-cancer-who-underwent-neoadjuvant-treatment-with-folfirinox
#7
Theodoros Michelakos, Ilaria Pergolini, Carlos Fernández-Del Castillo, Kim C Honselmann, Lei Cai, Vikram Deshpande, Jennifer Y Wo, David P Ryan, Jill N Allen, Lawrence S Blaszkowsky, Jeffrey W Clark, Janet E Murphy, Ryan D Nipp, Aparna Parikh, Motaz Qadan, Andrew L Warshaw, Theodore S Hong, Keith D Lillemoe, Cristina R Ferrone
OBJECTIVE: The aim of this study was to determine (1) whether preoperative factors can predict resectability of borderline resectable (BR) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant FOLFIRINOX, (2) which patients might benefit from adjuvant therapy, and (3) survival differences between resected BR/LA patients who received neoadjuvant FOLFIRINOX and upfront resected patients. BACKGROUND: Patients with BR/LA PDAC are often treated with FOLFIRINOX to obtain a margin-negative resection, yet selection of patients for resection remains challenging...
December 7, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/29224265/-analysis-on-the-clinical-therapeutic-effects-of-arterial-first-approach-pancreatoduodenectomy-in-the-treatment-of-borderline-resectable-pancreatic-adenocarcinoma
#8
G Jin, K L Zheng, S W Guo, Z Shao, C Liu, X H Shi, R D Liu, S J Bai, H Jiang, Y Bian, X G Hu
Objective: To compare the clinical therapeutic effects of arterial first approach pancreaticoduodenectomy(AFA-PD) with standard approach pancreaticoduodenectomy(SPD) in the treatment of borderline resectable pancreatic cancer (BRPC). Methods: A retrospective analysis of the clinical data of 113 cases of pancreatic cancer patients from January 2014 to August 2015 at Department of Hepato-Biliary-Pancreatic Surgery, Changhai Hospital, the Second Military Medical University, including 43 cases in AFA-PD group and 70 cases in SPD group...
December 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/29221719/integration-of-different-criteria-for-borderline-resectable-pancreatic-cancer-using-classification-tree-analysis-the-use-of-radiological-tumour-vascular-interface-in-correlation-with-surgical-and-pathological-outcomes
#9
J A Hwang, K M Jang, S H Kim, T W Kang, K D Song, D I Cha, S Ahn
AIM: To integrate various criteria for borderline resectable pancreatic cancer (BRPC) based on radiological parameters using classification tree analysis. MATERIALS AND METHODS: The institutional review board approved this retrospective study and waived the requirement for informed consent. Two hundred and thirty-five tumour-vein interfaces and 67 tumour-artery interfaces in 245 patients with surgically confirmed pancreatic ductal adenocarcinoma who underwent both preoperative computed tomography (CT) and magnetic resonance imaging (MRI) were assessed by two independent readers...
December 5, 2017: Clinical Radiology
https://www.readbyqxmd.com/read/29214453/neoadjuvant-therapy-versus-upfront-resection-for-pancreatic-cancer-the-actual-spectrum-and-clinical-burden-of-postoperative-complications
#10
Giovanni Marchegiani, Stefano Andrianello, Chiara Nessi, Marta Sandini, Laura Maggino, Giuseppe Malleo, Salvatore Paiella, Enrico Polati, Claudio Bassi, Roberto Salvia
BACKGROUND: Neoadjuvant therapy (NAT) is used for borderline-resectable or locally advanced pancreatic cancer (PDAC) and exhibits promising results in terms of pathological outcomes. However, little is known about its effect on surgical complications. METHODS: We analyzed 445 pancreatic resections for PDAC from 2014 to 2016 at The Pancreas Institute, Verona University Hospital. The Modified Accordion Severity Grading System and average complication burden (ACB) were used to compare patients treated with NAT with patients who underwent upfront surgery (UFS)...
December 6, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29198002/staging-of-pancreatic-cancer-resectable-borderline-resectable-and-unresectable-disease
#11
Erik V Soloff, Atif Zaheer, Jeffrey Meier, Marc Zins, Eric P Tamm
Pancreatic ductal adenocarcinoma (PDAC) is a relatively common malignancy that carries an overall poor prognosis, with five-year survival below 10%. Despite ongoing research, surgical resection remains the only potentially curative treatment. Therefore, accurate identification of those patients who would benefit from surgical resection is of paramount importance. High-quality imaging and image interpretation is central to this process. Radiology helps in the determination of whether patients are resectable, borderline resectable, or unresectable and guides treatment planning...
December 2, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/29191513/international-consensus-on-definition-and-criteria-of-borderline-resectable-pancreatic-ductal-adenocarcinoma-2017
#12
Shuji Isaji, Shugo Mizuno, John A Windsor, Claudio Bassi, Carlos Fernández-Del Castillo, Thilo Hackert, Aoi Hayasaki, Matthew H G Katz, Sun-Whe Kim, Masashi Kishiwada, Hirohisa Kitagawa, Christoph W Michalski, Christopher L Wolfgang
This statement was developed to promote international consensus on the definition of borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) which was adopted by the National Comprehensive Cancer Network (NCCN) in 2006, but which has changed yearly and become more complicated. Based on a symposium held during the 20th meeting of the International Association of Pancreatology (IAP) in Sendai, Japan, in 2016, the presenters sought consensus on issues related to BR-PDAC. We defined patients with BR-PDAC according to the three distinct dimensions: anatomical (A), biological (B), and conditional (C)...
November 22, 2017: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
https://www.readbyqxmd.com/read/29189330/clinical-management-resectable-disease
#13
Rebekah R White, Andrew M Lowy
Despite the identification of more active systemic therapy combinations for pancreatic cancer, cures remain elusive and feasible only in patients with localized, operable disease. When examining outcome data from phase III adjuvant trials conducted during the past decade, the survival for patients with localized disease has improved, likely owing to a combination of factors including more active adjuvant therapy and improved surgical and perioperative care. Perhaps the greatest recent change in the care of patients with localized pancreatic cancer has been the extension of surgery to tumors previously thought to be inoperable because of involvement of major blood vessels...
November 2017: Cancer Journal
https://www.readbyqxmd.com/read/29188307/-criteria-for-resectability-of-pancreatic-cancer-and-postoperative-imaging
#14
L Grenacher, M Juchems
By improving the techniques of pancreatic surgery, the mortality and morbidity for pancreatic carcinoma could be significantly reduced. For radiologists a profound knowledge of the surgical techniques is of decisive importance. Based on this knowledge postoperative complications can be reliably uncovered and local recurrences can be detected at an early stage. The complications resulting from pancreatic surgery can be severe and often necessitate a radiological intervention. As pancreatic cancer itself is a severe disease with a poor 5‑year survival, which can only be improved by an R0 resection, it is crucial to identify using imaging those patients who are primarily operable or who can potentially achieve an operable condition through neoadjuvant chemotherapy (borderline) and inoperable patients to avoid postoperative complications which would additionally weaken them and result in unnecessary delays in initiating palliative therapy...
November 29, 2017: Der Radiologe
https://www.readbyqxmd.com/read/29187490/a-prospective-study-of-intensity-modified-radiation-therapy-in-comparison-with-conventional-3d-rt-for-br-pancreatic-cancer-patients-with-arterial-involvement
#15
Toshihiko Masui, Kyoichi Takaori, Takayuki Anazawa, Asahi Sato, Kenzo Nakano, Yuichiro Uchida, Akitada Yogo, Yoko Goto, Shigemi Matsumoto, Yuzo Kodama, Masashi Kanai, Hiroyoshi Isoda, Masaki Mizumoto, Yoshiya Kawaguchi, Keiko Shibuya, Satoshi Itasaka, Shinji Uemoto
BACKGROUND/AIM: Intensity-modulated radiation therapy (IMRT) is a form of radiation therapy that allows accurate irradiation with reduced damage to surrounding tissues. Here, we analyzed borderline-resectable pancreatic cancer (BRPC) with arterial abutment (BR-A) patients with IMRT as neoadjuvant therapy and performed comparisons with patients with conventional RT to clarify the advantages of IMRT as a neoadjuvant therapy. PATIENTS AND METHODS: Thirty BR-A patients treated at our hospital between January 2012 and December 2015 were divided into two groups: 12 patients underwent conventional 3D-RT before resection (RT group); and 18 patients underwent IMRT before resection (IMRT group)...
December 2017: Anticancer Research
https://www.readbyqxmd.com/read/29180208/mzb1-in-borderline-resectable-pancreatic-cancer-resected-after-neoadjuvant-chemoradiotherapy
#16
Kentaro Miyake, Ryutaro Mori, Yuki Homma, Ryusei Matsuyama, Akiko Okayama, Takashi Murakami, Hisashi Hirano, Itaru Endo
BACKGROUND: A high accumulation of CD8+ tumor-infiltrating lymphocytes (TILs) induced by neoadjuvant chemoradiotherapy (NACRT) is associated with a favorable prognosis in patients with pancreatic ductal adenocarcinoma (PDAC). However, the correlation between a high accumulation of CD8+ TILs and a favorable prognosis has yet to be fully clarified. The aim of this study was to determine predictive markers of a high accumulation of CD8+ TILs, with a favorable prognosis, using proteomic analysis...
December 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/29153290/locally-advanced-pancreatic-cancer-an-emerging-entity
#17
REVIEW
Grainne M O Kane, Jennifer J Knox
Pancreatic adenocarcinoma (PDAC) remains a highly fatal disease that is increasing in incidence. PDAC can be classified according to resectability status with 3 nonmetastatic groups defined: resectable, borderline resectable, and locally advanced PDAC (LAPC). Delineating these subtypes is important with the optimal treatment approach dictated by high-quality CT imaging and multidisciplinary team discussion. Patients with LAPC are thought unresectable and are therefore rarely cured. In these patients, chemotherapy remains the mainstay of treatment...
November 16, 2017: Current Problems in Cancer
https://www.readbyqxmd.com/read/29143898/the-multidisciplinary-approach-to-localized-pancreatic-adenocarcinoma
#18
REVIEW
Hiral D Parekh, Jason Starr, Thomas J George
Pancreatic adenocarcinoma 2030 (PCa) is predicted to be the second leading cause of cancer death in USA by 2030. To date, attempts at early detection have been unsuccessful. Therapies for resectable PCa include surgery followed by adjuvant chemotherapy with or without radiotherapy. Unfortunately, most patients with PCa present with advanced disease and thus only 20% of patients are potentially resectable upon presentation. Improved surgical techniques along with adjuvant combination chemotherapy have improved outcomes for patients with resectable disease...
November 16, 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/29139084/common-hepatic-artery-abutment-or-encasement-is-an-adverse-prognostic-factor-in-patients-with-borderline-and-unresectable-pancreatic-cancer
#19
Geoffrey M Kozak, Jeffrey D Epstein, Sandeep P Deshmukh, Benjamin B Scott, Scott W Keith, Harish Lavu, Charles J Yeo, Jordan M Winter
BACKGROUND: Localized and unresectable pancreatic ductal adenocarcinoma (PDA) comprises one third of new diagnoses and includes borderline resectable (BR) and locally advanced (LA) unresectable disease. In a cohort of patients who were treated and followed at a single institution, we assessed clinical and radiographic predictors of outcome. METHODS: The study included 69 consecutive patients with BR or LA PDA. Serial imaging studies were reviewed by both a pancreatic surgeon and a radiologist for vascular abutment or encasement by cancer, and they were recorded...
November 14, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29094173/imaging-of-post-operative-pancreas-and-complications-after-pancreatic-adenocarcinoma-resection
#20
Nima Hafezi-Nejad, Elliot K Fishman, Atif Zaheer
Pancreatic ductal adenocarcinoma is one of the leading causes of cancer-related deaths. With surgical resection being the only definitive treatment, improvements in technique has led to an increase in number of candidates undergoing resection by inclusion of borderline resectable disease patients to the clearly resectable group. Post-operative complications associated with pancreaticoduodenectomy and distal pancreatectomy include delayed gastric emptying, anastomotic failures, fistula formation, strictures, abscess, infarction, etc...
November 1, 2017: Abdominal Radiology
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