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Borderline resectable pancreatic cancer

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
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)...
February 28, 2018: AJR. American Journal of Roentgenology
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
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 23, 2018: Abdominal Radiology
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
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...
February 16, 2018: Gastroenterology
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...
February 15, 2018: Translational Oncology
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
Alex B Blair, Lauren M Rosati, Neda Rezaee, Georgios Gemenetzis, Lei Zheng, Ralph H Hruban, John L Cameron, Matthew J Weiss, Christopher L Wolfgang, Joseph M Herman, Jin He
BACKGROUND: The impact of neoadjuvant stereotactic body radiation therapy on postoperative complications for patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma remains unclear. Limited studies have compared neoadjuvant stereotactic body radiation therapy versus conventional chemoradiation therapy. A retrospective study was performed to determine if perioperative complications were different among patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma receiving neoadjuvant stereotactic body radiation therapy or chemoradiation therapy...
January 25, 2018: Surgery
Noriyuki Ohno, Makoto Ishida, Kenji Ohnishi, Katsuji Sawai, Shinsuke Tabata, Masaaki Deguchi, Tatsumi Kitajima, Yasuharu Kaizaki
We report a resected case with a pathological complete response(pCR)after neoadjuvant chemotherapy for borderline resectable pancreatic cancer(BRPC). A 67-year-old woman who had been treated for type 2 diabetes mellitus in our hospital presented with an exacerbation of diabetes. An abdominal CT scan confirmed a hypovascular mass in the pancreas body consistent with BRPC. After 3 courses of chemotherapy with gemcitabine plus nab-paclitaxel(GnP), her elevated DUPAN-2 level normalized. A follow up CT scan revealed that the tumor had decreased in size, and no distant metastasis was detected...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Alejandro Garces-Descovich, Kevin Beker, Adrian Jaramillo-Cardoso, A James Moser, Koenraad J Mortele
PURPOSE: To test the applicability of National Comprehensive Cancer Network (NCCN v 3.2017) resectability criteria for pancreatic ductal adenocarcinoma (PDAC) in clinical practice, at a high-volume tertiary referral center. MATERIALS AND METHODS: 102 consecutive patients (53 female; mean age 66.2 years, range 34-90 years) with biopsy proven, non-metastatic PDAC were evaluated by our multidisciplinary pancreatic cancer program between July 2013 and February 2016...
February 1, 2018: Abdominal Radiology
Jacob E Shabason, Jerry Chen, Smith Apisarnthanarax, Nevena Damjanov, Bruce Giantonio, Arturo Loaiza-Bonilla, Peter J O'Dwyer, Mark O'Hara, Kim A Reiss, Ursina Teitelbaum, Paul Wissel, Jeffrey A Drebin, Charles Vollmer, Michael Kochman, Rosemarie Mick, Norge Vergara, Nirag Jhala, Abigail Doucette, John N Lukens, John P Plastaras, James M Metz, Edgar Ben-Josef
PURPOSE: Patients with locally advanced pancreatic cancer typically have poor outcomes, with a median survival of approximately 16 months. Novel methods to improve outcomes are needed. Nab-paclitaxel (Abraxane) has shown efficacy in pancreatic cancer and is FDA-approved for metastatic disease in combination with gemcitabine. Nab-paclitaxel is also a promising radiosensitizer based on laboratory studies, but it has never been clinically tested with definitive radiotherapy for locally advanced pancreatic carcinoma...
January 23, 2018: Cancer Chemotherapy and Pharmacology
Anuhya Kommalapati, Sri Harsha Tella, Gaurav Goyal, Wen Wee Ma, Amit Mahipal
Pancreatic cancer is the third most common cause of cancer deaths in the United States. Surgical resection with negative margins still constitutes the cornerstone of potentially curative therapy, but is possible only in 15-20% of patients at the time of initial diagnosis. Accumulating evidence suggests that the neoadjuvant approach may improve R0 resection rate in localized resectable and borderline resectable diseases, and potentially downstage locally advanced disease to achieve surgical resection, though the impact on survival is to be determined...
January 20, 2018: Cancers
Shinichiro Takahashi
Borderline resectable pancreatic cancer (BRPC) is an advanced tumor in contact with the surrounding major vessels, making R0 resection difficult to achieve. Neoadjuvant treatment is expected to provide substantial local control and prolong survival. However, there is no standard treatment. I therefore conducted a strategic literature search from January 2013 to September 2017 and identified 37 clinical studies of pancreatic cancer, including BRPC, to evaluate treatment interventions. Twenty (54%) studies were prospective...
January 11, 2018: Japanese Journal of Clinical Oncology
Ruediger Goess, Helmut Friess
Pancreatic cancer is known to be the deadliest of all common cancers. Despite all efforts in pancreatic cancer treatment, the five-year survival rates at diagnosis over the past 20 years have only increased from 5% to 8%. Assuming that pancreatic cancer is going to become the second most frequent cause of cancer related death in the next 20 years, we are all encouraged to treat patients in clinical trials to gain improvements in this devastating disease. Areas covered: This review will provide a summary of pancreatic cancer treatment over the last 20 years, starting with the pivotal study in 1997 which showed the superiority of gemcitabine over 5-FU in advanced pancreatic cancer and is marked as the beginning of a new era in pancreatic cancer treatment...
January 16, 2018: Expert Review of Anticancer Therapy
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
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
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
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
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.]
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