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Borderline resectable pancreatic cancer

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https://www.readbyqxmd.com/read/28105634/does-radiologic-response-correlate-to-pathologic-response-in-patients-undergoing-neoadjuvant-therapy-for-borderline-resectable-pancreatic-malignancy
#1
Brent T Xia, Baojin Fu, Jiang Wang, Young Kim, S Ameen Ahmad, Vikrom K Dhar, Nick C Levinsky, Dennis J Hanseman, David A Habib, Gregory C Wilson, Milton Smith, Olugbenga O Olowokure, Jordan Kharofa, Ali H Al Humaidi, Kyuran A Choe, Daniel E Abbott, Syed A Ahmad
BACKGROUND AND OBJECTIVES: In patients with borderline resectable pancreas cancers, clinicians frequently consider radiographic response as the primary driver of whether patients should be offered surgical intervention following neoadjuvant therapy (NT). We sought to determine any correlation between radiographic and pathologic response rates following NT. METHODS: Between 2005 and 2015, 38 patients at a tertiary care referral center underwent NT followed by pancreaticoduodenectomy for borderline resectable pancreas cancer...
January 20, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28089484/dosimetric-parameters-correlate-with-duodenal-histopathologic-damage-after-stereotactic-body-radiotherapy-for-pancreatic-cancer-secondary-analysis-of-a-prospective-clinical-trial
#2
Vivek Verma, Audrey J Lazenby, Dandan Zheng, Abhijeet R Bhirud, Quan P Ly, Chandrakanth Are, Aaron R Sasson, Chi Lin
PURPOSE: Prospectively assess relationships between dosimetric parameters and histopathologic/clinical duodenal toxicities in patients on a phase I trial for pancreatic cancer. METHODS: Forty-six borderline resectable/unresectable patients were enrolled on a prospective trial testing neoadjuvant gemcitabine/5-fluorouracil followed by SBRT (5 daily fractions of 5-8Gy) and concurrent nelfinavir. Post-SBRT surgery was performed in 13 resectable patients, which constituted the patient population herein...
January 12, 2017: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
https://www.readbyqxmd.com/read/28056259/-progress-in-neoadjuvant-and-transformation-therapy-of-pancreatic-cancer
#3
D D Hu, M H Dai
Pancreatic adenocarcinoma is a malignant disease with considerable metastatic potential.While surgical resection can be potentially curative, tumor recurrence remains an important cause of treatment failure.Neoadjuvant chemotherapy can increase rate of resectability by decreasing tumor burden and decrease recurrence rate by clearing microscopic disease in lymph nodes and vessels.Currently, neoadjuvant therapy is recommended for patients with resectable who has signs of high risks or borderline resectable pancreatic adenocarcinoma...
January 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/28054192/five-year-actual-overall-survival-in-resected-pancreatic-cancer-a-contemporary-single-institution-experience-from-a-multidisciplinary-perspective
#4
Vincent J Picozzi, Stephen Y Oh, Alicia Edwards, Margaret T Mandelson, Russell Dorer, Flavio G Rocha, Adnan Alseidi, Thomas Biehl, L William Traverso, William S Helton, Richard A Kozarek
BACKGROUND: Successful surgical resection combined with effective perioperative therapy is essential for maximizing long-term survival for pancreatic adenocarcinoma. PATIENTS AND METHODS: All patients with pancreatic adenocarcinoma who underwent curative resection at our institution from January 2003 to May 2010 were reviewed. Demographic and clinical details were retrospectively collected from medical records and cancer registry data. RESULTS: Overall, 176 patients were included in the analysis (148 with de novo resectable disease and 28 with borderline resectable disease at presentation)...
January 4, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28050151/eastern-canadian-gastrointestinal-cancer-consensus-conference-2016
#5
D Bossé, T Ng, C Ahmad, A Alfakeeh, I Alruzug, J Biagi, J Brierley, P Chaudhury, S Cleary, B Colwell, C Cripps, L A Dawson, M Dorreen, E Ferland, P Galiatsatos, S Girard, S Gray, F Halwani, N Kopek, A Mahmud, G Martel, L Robillard, B Samson, M Seal, J Siddiqui, L Sideris, S Snow, M Thirwell, M Vickers, R Goodwin, R Goel, T Hsu, E Tsvetkova, B Ward, T Asmis
The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference 2016 was held in Montreal, Quebec, 5-7 February. Experts in radiation oncology, medical oncology, surgical oncology, and infectious diseases involved in the management of patients with gastrointestinal malignancies participated in presentations and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses multiple topics: ■ Follow-up and survivorship of patients with resected colorectal cancer■ Indications for liver metastasectomy■ Treatment of oligometastases by stereotactic body radiation therapy■ Treatment of borderline resectable and unresectable pancreatic cancer■ Transarterial chemoembolization in hepatocellular carcinoma■ Infectious complications of antineoplastic agents...
December 2016: Current Oncology
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
#6
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/28046466/su-f-t-395-evaluation-of-best-dosimetry-achievable-with-vmat-and-imrt-treatment-techniques-targeting-borderline-resectable-pancreatic-cancer
#7
K Harpool, E Schnell, T Herman, S Ahmad, T De La Fuente Herman
PURPOSE: To determine from retrospective study the most appropriate technique for targeting small borderline operable pancreatic cancer surrounding blood vessels by evaluating the dosimetry and normal tissue sparing achievable using Volumetric Modulated Arc Therapy (VMAT) and Intensity Modulated Radiation Therapy (IMRT). METHODS: Treatment plans from ten patients who have undergone treatment with a prescribed dose of 4950 cGy, at 275 cGy per fraction, were analyzed...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/27938571/-surgical-treatment-of-pancreatic-carcinoma-problems-and-recent-advances
#8
Y M Yang, Y P Zhao
Nowadays surgical technologies develop fast under the guidance of minimally invasive medicine, evidence-based medicine, multi-disciplinary team and other ideas. However, the long-term outcome of pancreatic cancer remains dismal. In addition to the improvement of surgical resection rate, more attention should be paid to improve the overall survival rate of the patients with pancreatic cancer after surgery. Clinical studies of neoadjuvant therapies for the treatment of borderline resectable pancreatic cancer are advocated...
1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/27935952/neoadjuvant-gemcitabine-chemotherapy-followed-by-concurrent-imrt-simultaneous-boost-achieves-high-r0-resection-in-borderline-resectable-pancreatic-cancer-patients
#9
Xiaolun Huang, Jeanna L Knoble, Ming Zeng, Fernando N Aguila, Tara Patel, Lowell W Chambers, Honglin Hu, Hao Liu
BACKGROUND: To study the feasibility of down stage the borderline resectable pancreatic cancer (BRPC) to resectable disease, we reported our institutional results using an intensity-modulated radiation therapy (IMRT) simultaneous integrated boost (SIB) dose escalation approach to improve R0 resectability. METHODS: We reviewed our past 7 years of experience of using neoadjuvant induction chemotherapy with Gemcitabine followed by concurrent chemoradiaiton for BRPC...
2016: PloS One
https://www.readbyqxmd.com/read/27931968/borderline-resectable-pancreatic-cancer-more-than-an-anatomical-concept
#10
Fausto Petrelli, Alessandro Inno, Sandro Barni, Antonio Ghidini, Roberto Labianca, Massimo Falconi, Michele Reni, Stefano Cascinu
Borderline resectable pancreatic cancer (BRPC) accounts for about 10-15% of newly diagnosed pancreatic cancer, and its management requires a skilled multidisciplinary team. The main definition of BRPC refers to resectability, but also a high risk of positive surgical margins and recurrence. This raises questions about the value of surgery and suggests an opportunity to utilize preoperative treatment in this subset of patients. Besides technical borderline resectable disease which is defined on anatomical and radiological criteria, there is also a biological borderline resectable disease which is defined on clinical and biological prognostic factors...
December 5, 2016: Digestive and Liver Disease
https://www.readbyqxmd.com/read/27896658/poor-glycemic-control-is-associated-with-failure-to-complete-neoadjuvant-therapy-and-surgery-in-patients-with-localized-pancreatic-cancer
#11
E S Paul Rajamanickam, K K Christians, M Aldakkak, A N Krepline, P S Ritch, B George, B A Erickson, W D Foley, M Aburajab, D B Evans, S Tsai
BACKGROUND: The impact of glycemic control in patients with pancreatic cancer treated with neoadjuvant therapy is unclear. METHODS: Glycated hemoglobin (HbA1c) values were measured in patients with localized pancreatic cancer prior to any therapy (pretreatment) and after neoadjuvant therapy prior to surgery (preoperative). HbA1c levels greater than 6.5% were classified as abnormal. Patients were categorized based on the change in HbA1c levels from pretreatment to preoperative: GrpA, always normal; Gr B, worsened; GrpC, improved; and GrpD, always abnormal...
November 28, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/27896637/seom-clinical-guideline-for-the-treatment-of-pancreatic-cancer-2016
#12
R Vera, E Dotor, J Feliu, E González, B Laquente, T Macarulla, E Martínez, J Maurel, M Salgado, J L Manzano
Pancreatic cancer remains an aggressive disease with a 5 year survival rate of 5%. Only 15% of patients with pancreatic cancer are eligible for radical surgery. Evidence suggests a benefit on survival with adjuvant chemotherapy (gemcitabine o fluourouracil) after R1/R0 resection. Adjuvant chemoradiotherapy is also a valid option in patients with positive margins. Borderline resectable pancreatic cancer is defined as the involvement of the mesenteric vasculature with a limited extension. These tumors are technically resectable, but with a high risk of positive margins...
December 2016: Clinical & Translational Oncology
https://www.readbyqxmd.com/read/27896469/ct-evaluation-after-neoadjuvant-folfirinox-chemotherapy-for-borderline-and-locally-advanced-pancreatic-adenocarcinoma
#13
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/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
#14
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
#15
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/27865282/techniques-of-vascular-resection-and-reconstruction-in-pancreatic-cancer
#16
REVIEW
George Younan, Susan Tsai, Douglas B Evans, Kathleen K Christians
Multimodality therapy has become the standard approach for the treatment of pancreatic cancer. With improved response rates to newer chemotherapeutic agents, tumors that used to be considered unresectable are now being considered for operation. Neoadjuvant therapy for borderline resectable pancreatic cancer is considered standard of care and venous resection/reconstruction is no longer controversial. Arterial resection and reconstruction in select patients has also proven to be safe when done in highly specialized centers by high-volume surgeons...
December 2016: Surgical Clinics of North America
https://www.readbyqxmd.com/read/27865281/definition-and-management-of-borderline-resectable-pancreatic-cancer
#17
REVIEW
Jason W Denbo, Jason B Fleming
Patients with localized pancreatic ductal adenocarcinoma seek potentially curative treatment, but this group represents a spectrum of disease. Patients with borderline resectable primary tumors are a unique subset whose successful therapy requires a care team with expertise in medical care, imaging, surgery, medical oncology, and radiation oncology. This team must identify patients with borderline tumors then carefully prescribe and execute a combined treatment strategy with the highest possibility of cure...
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
#18
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
#19
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/27813710/usefulness-of-three-dimensional-modeling-in-surgical-planning-resident-training-and-patient-education
#20
Ciro Andolfi, Alejandro Plana, Patrick Kania, P Pat Banerjee, Stephen Small
BACKGROUND: Imaging has a critical impact on surgical decision making and three-dimensional (3D) digital models of patient pathology can now be made commercially. We developed a 3D digital model of a cancer of the head of the pancreas by integrating actual CT data with 3D modeling process. After this process, the virtual pancreatic model was also produced using a high-quality 3D printer. PATIENTS AND METHODS: A 56-year-old female with pancreatic head adenocarcinoma presented with biliary obstruction and jaundice...
November 4, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
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