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Borderline resectable pancreatic cancer

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https://www.readbyqxmd.com/read/29773761/surgical-treatment-of-pancreatic-cancer
#1
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/29722658/management-of-borderline-resectable-pancreatic-cancer
#2
REVIEW
Diego A S Toesca, Amanda J Koong, George A Poultsides, Brendan C Visser, Sigurdis Haraldsdottir, Albert C Koong, Daniel T Chang
With the rapid development of imaging modalities and surgical techniques, the clinical entity representing tumors that are intermediate between resectable and unresectable pancreatic adenocarcinoma has been identified has been termed "borderline resectable" (BR). These tumors are generally amenable for resection but portend an increased risk for positive margins after surgery and commonly necessitate vascular resection and reconstruction. Although there is a lack of consensus regarding the appropriate definition of what constitutes a BR pancreatic tumor, it has been demonstrated that this intermediate category carries a particular prognosis that is in between resectable and unresectable disease...
April 1, 2018: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/29717230/therapeutic-developments-in-pancreatic-cancer-current-and-future-perspectives
#3
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/29708592/meta-analysis-comparing-upfront-surgery-with-neoadjuvant-treatment-in-patients-with-resectable-or-borderline-resectable-pancreatic-cancer
#4
REVIEW
E Versteijne, J A Vogel, M G Besselink, O R C Busch, J W Wilmink, J G Daams, C H J van Eijck, B Groot Koerkamp, C R N Rasch, G van Tienhoven
BACKGROUND: Studies comparing upfront surgery with neoadjuvant treatment in pancreatic cancer may report only patients who underwent resection and so survival will be skewed. The aim of this study was to report survival by intention to treat in a comparison of upfront surgery versus neoadjuvant treatment in resectable or borderline resectable pancreatic cancer. METHODS: MEDLINE, Embase and the Cochrane Library were searched for studies reporting median overall survival by intention to treat in patients with resectable or borderline resectable pancreatic cancer treated with or without neoadjuvant treatment...
April 30, 2018: British Journal of Surgery
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
#5
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/29672417/preoperative-chemoradiation-for-borderline-resectable-pancreatic-cancer-the-new-standard
#6
Matthew Hg Katz, Michael P Kim, Ching-Wei Tzeng, Jeffrey E Lee
No abstract text is available yet for this article.
April 18, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29668371/comparison-of-metal-and-plastic-stents-for-preoperative-biliary-drainage-in-resectable-and-borderline-resectable-periampullary-cancer-a-meta-analysis-and-system-review
#7
Pan Liu, Huapeng Lin, Yuanyuan Chen, Yu-Shen Wu, Maocai Tang, Changan Liu
AIM: The aim of this study was to compare the plastic stents with metal stents for preoperative biliary drainage (PBD) in terms of the rate of endoscopic reintervention and PBD-related pre- and postoperative complications in patients with resectable and borderline resectable periampullary cancer. METHODS: We conducted a comprehensive search of the PubMed, EMBASE, and the Cochrane Library database to identify relevant available articles from their inception to September 2017...
April 18, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/29649825/the-role-of-staging-laparoscopy-in-resectable-and-borderline-resectable-pancreatic-cancer-a-systematic-review-and-meta-analysis
#8
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
https://www.readbyqxmd.com/read/29629335/intraoperative-radiation-boost-to-the-surgical-resection-bed-following-pancreaticoduodenectomy-for-a-borderline-resectable-pancreatic-carcinoma-a-case-report
#9
Tarita O Thomas, William Small, Mark Fleming, Song Kang, Richard A Hoefer
Neoadjuvant therapy including chemotherapy alone or concurrent chemotherapy with external bream radiation is a standard treatment strategy for borderline resectable pancreatic adenocarcinoma and is also used routinely for primary operable cancers at some institutions (1). The use of intraoperative radiation therapy (IORT) has been limited largely because of the logistical issues in delivery of radiation during surgery (2). This is the first reported case of a borderline resectable pancreas cancer patient who underwent neoadjuvant chemo-radiation therapy followed by resection with the use of IORT using the mobile IntraBeam device to boost the resection bed and improve local control by dose escalation...
2018: Frontiers in Oncology
https://www.readbyqxmd.com/read/29602996/laparoscopic-pancreaticoduodenectomy-with-major-venous-resection-and-reconstruction-anterior-superior-mesenteric-artery-first-approach
#10
Yunqiang Cai, Pan Gao, Yongbin Li, Xin Wang, Bing Peng
BACKGROUND: The en bloc resection of the superior mesenteric or portal vein with concomitant venous reconstruction may be required in patients with borderline resectable pancreatic cancer. However, performing laparoscopic pancreaticoduodenectomy (LPD) with major venous resection and reconstruction is technically challenging. Herein, we introduced a safe and feasible technique to perform LPD with major venous resection. METHODS: Over the period of November 2015 to November 2016, 18 patients underwent laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction using the anterior superior mesenteric artery (SMA)-first approach at our institution...
March 30, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29590448/18f-fluorodeoxyglucose-positron-emission-tomography-to-indicate-conversion-surgery-in-patients-with-initially-unresectable-locally-advanced-pancreatic-cancer
#11
Keiichi Okano, Hironobu Suto, Minoru Oshima, Yasuhisa Ando, Mina Nagao, Hideki Kamada, Hideki Kobara, Tsutomu Masaki, Hiroyuki Okuyama, Yoshihiro Okita, Akihito Tsuji, Yasuyuki Suzuki
Objective: Advances in chemotherapy and chemoradiotherapy have enabled conversion of initially unresectable locally advanced (UR-LA) pancreatic adenocarcinoma (PDAC) to a resectable disease. However, definitive criteria for conversion surgery have not been established. We evaluated the potential of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) to indicate conversion surgery in patients with primary UR-LA PDAC. Methods: Twenty consecutive patients with UR-LA PDAC underwent chemoradiation or chemotherapy followed by assessment with FDG-PET...
March 26, 2018: Japanese Journal of Clinical Oncology
https://www.readbyqxmd.com/read/29564168/impact-of-sarcopenia-in-borderline-resectable-and-locally-advanced-pancreatic-cancer-patients-receiving-stereotactic-body-radiation-therapy
#12
William H Jin, Eric A Mellon, Jessica M Frakes, Gilbert Z Murimwa, Pamela J Hodul, Jose M Pimiento, Mokenge P Malafa, Sarah E Hoffe
Background: Total psoas area (TPA), a marker of sarcopenia, has been used as an independent predictor of clinical outcomes in gastrointestinal (GI) cancers as a proxy for frailty and nutritional status. Our study aimed to evaluate whether TPA, in contrast to traditional measurements of nutrition like body mass index (BMI) and body surface area (BSA), was predictive of outcomes in borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) patients receiving stereotactic body radiation therapy (SBRT)...
February 2018: Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/29510561/survival-analysis-in-patients-with-pancreatic-ductal-adenocarcinoma-undergoing-chemoradiotherapy-followed-by-surgery-according-to-the-international-consensus-on-the-2017-definition-of-borderline-resectable-cancer
#13
Aoi Hayasaki, Shuji Isaji, Masashi Kishiwada, Takehiro Fujii, Yusuke Iizawa, Hiroyuki Kato, Akihiro Tanemura, Yasuhiro Murata, Yoshinori Azumi, Naohisa Kuriyama, Shugo Mizuno, Masanobu Usui, Hiroyuki Sakurai
Background : The aim of this study was to validate a new definition of borderline resectable pancreatic ductal adenocarcinoma (PDAC) provided by the 2017 international consensus on the basis of three dimensions of anatomical (A), biological (B), and conditional (C) factors, using the data of the patients who had been registered for our institutional protocol of chemoradiotherapy followed by surgery (CRTS) for localized patients with PDAC. Methods : Among 307 consecutive patients pathologically diagnosed with localized PDAC who were enrolled in our CRTS protocol from February 2005 to December 2016, we selected 285 patients who could be re-evaluated after CRT...
March 5, 2018: Cancers
https://www.readbyqxmd.com/read/29489408/preoperative-mdct-assessment-of-resectability-in-borderline-resectable-pancreatic-cancer-effect-of-neoadjuvant-chemoradiation-therapy
#14
Ijin Joo, Jeong Min Lee, Eun Sun Lee, Su Joa Ahn, Dong Ho Lee, Sun-Whe Kim, Ji Kon Ryu, Do-Youn Oh, Kyubo Kim, Kyoung-Bun Lee, Jin-Young Jang
OBJECTIVE: The purpose of this study is to evaluate the diagnostic performance of MDCT in assessing tumor resectability in patients with borderline resectable pancreatic cancers after receiving neoadjuvant chemoradiation therapy (CRT) in comparison with those undergoing upfront surgery. SUBJECTS AND METHODS: Thirty-seven patients with borderline resectable pancreatic cancers were randomly allocated to the neoadjuvant CRT group (arm 1; n = 18) or up-front surgery group (arm 2; n = 19)...
May 2018: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/29483443/-conversion-surgery-for-pancreatic-head-cancer-with-peritoneal-dissemination-following-chemotherapy-for-two-years-a-case-report
#15
Yuuri Hatsuzawa, Masamichi Mizuma, Fuyuhiko Motoi, Tatsuo Hata, Masahiro Iseki, Tatsuyuki Takadate, Hideo Ohtsuka, Naoaki Sakata, Takanori Morikawa, Kei Nakagawa, Hiroki Hayashi, Takeshi Naitoh, Atsushi Kanno, Tooru Shimosegawa, Michiaki Unno
Here we report a case of pancreatic cancer(PC)with peritoneal dissemination, underwent conversion surgery following chemotherapy for 2 years. A5 5-year-old woman was referred to our hospital for treatment of PC. Abdominal CT scan revealed 3.0 cm of a pancreatic head tumor with abutment of the portal vein and the hepatic artery, classified as borderline resectable. Staging laparoscopy(SL)showed positive peritoneal cytology(CY). Gemcitabine(Gem)plus S-1 therapy(GS) was performed. Ten months after initial GS, SL revealed the disseminated nodule and positive CY...
February 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29473093/assessment-of-iodine-uptake-by-pancreatic-cancer-following-chemotherapy-using-dual-energy-ct
#16
REVIEW
Satomi Kawamoto, Matthew K Fuld, Daniel Laheru, Peng Huang, Elliot K Fishman
Pancreatic cancer remains a major health problem, and only less than 20% of patients have resectable disease at the time of initial diagnosis. Systemic chemotherapy is often used in the patients with borderline resectable, locally advanced unresectable disease and metastatic disease. CT is often used to assess for therapeutic response; however, conventional imaging including CT may not correctly reflect treatment response after chemotherapy. Dual-energy (DE) CT can acquire datasets at two different photon spectra in a single CT acquisition, and permits separating materials and extract iodine by applying a material decomposition algorithm...
February 2018: Abdominal Radiology
https://www.readbyqxmd.com/read/29462005/oncological-benefits-of-neoadjuvant-chemoradiation-with-gemcitabine-versus-upfront-surgery-in-patients-with-borderline-resectable-pancreatic-cancer-a-prospective-randomized-open-label-multicenter-phase-2-3-trial
#17
Jin-Young Jang, Youngmin Han, Hongeun Lee, Sun-Whe Kim, Wooil Kwon, Kyung-Hun Lee, Do-Youn Oh, Eui Kyu Chie, Jeong Min Lee, Jin Seok Heo, Joon Oh Park, Do Hoon Lim, Seong Hyun Kim, Sang Jae Park, Woo Jin Lee, Young Hwan Koh, Joon Seong Park, Dong Sup Yoon, Ik Jae Lee, Seong Ho Choi
OBJECTIVE: This study was performed to determine whether neoadjuvant treatment increases survival in patients with BRPC. SUMMARY BACKGROUND DATA: Despite many promising retrospective data on the effect of neoadjuvant treatment for borderline resectable pancreatic cancer (BRPC), no high-level evidence exists to support the role of such treatment. METHODS: This phase 2/3 multicenter randomized controlled trial was designed to enroll 110 patients with BRPC who were randomly assigned to gemcitabine-based neoadjuvant chemoradiation treatment (54 Gray external beam radiation) followed by surgery or upfront surgery followed by chemoradiation treatment from four large-volume centers in Korea...
February 16, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29458151/endoscopic-management-of-pancreatobiliary-neoplasms
#18
Andrew Y Wang, Patrick S Yachimski
Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are the mainstays of interventional endoscopic practice. EUS occupies a central role in the diagnosis of pancreatobiliary neoplasms and offers a platform for a wide range of direct tumor therapies. Initial steps have demonstrated the feasibility of such applications in animal models and pilot studies. Larger clinical trials and incorporation of EUS-based therapies into cooperative cancer studies might demonstrate an impact in the clinical prognosis of patients with pancreatic cancer...
May 2018: Gastroenterology
https://www.readbyqxmd.com/read/29455085/correlation-of-adc-with-pathological-treatment-response-for-radiation-therapy-of-pancreatic-cancer
#19
Entesar Dalah, Beth Erickson, Kiyoko Oshima, Diane Schott, William A Hall, Eric Paulson, An Tai, Paul Knechtges, X Allen Li
PURPOSE: To investigate the feasibility of using apparent diffusion coefficient (ADC) to assesspathological treatment response in pancreatic ductal adenocarcinoma (PDAC) following neoadjuvant chemoradiation (nCR). MATERIALS/METHODS: MRI and pathological data collected for 25patients with resectable and borderline resectable PDAC following nCR were retrospectively analyzed. Pre- and post-nCR mean ADC values in the tumors were compared using Wilcoxon matched pairs test...
April 2018: Translational Oncology
https://www.readbyqxmd.com/read/29448308/perioperative-outcomes-and-survival-following-neoadjuvant-stereotactic-body-radiation-therapy-sbrt-versus-intensity-modulated-radiation-therapy-imrt-in-pancreatic-adenocarcinoma
#20
Brandon C Chapman, Ana Gleisner, Devin Rigg, Cheryl Meguid, Karyn Goodman, Brian Brauer, Csaba Gajdos, Richard D Schulick, Barish H Edil, Martin D McCarter
BACKGROUND AND OBJECTIVES: To compare outcomes in patients receiving neoadjuvant stereotactic body radiation therapy (SBRT) with those receiving intensity-modulated radiation therapy (IMRT) for pancreatic adenocarcinoma. METHODS: We analyzed patients receiving neoadjuvant SBRT for borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) (2012-2016). Differences in baseline characteristics, perioperative outcomes, progression-free survival (PFS), and overall survival (OS) were compared...
February 15, 2018: Journal of Surgical Oncology
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