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Borderline resectable pancreatic cancer

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https://www.readbyqxmd.com/read/28427822/reassessment-of-the-clinical-significance-of-portal-superior-mesenteric-vein-invasion-in-borderline-resectable-pancreatic-cancer
#1
S Hoshimoto, S Hishinuma, H Shirakawa, M Tomikawa, I Ozawa, S Wakamatsu, S Hoshi, N Hoshi, K Hirabayashi, Y Ogata
OBJECTIVE: The principal objective of this study is to clarify the prognostic significance of borderline resectable pancreatic cancer (BRPC). The second objective is to evaluate the prognostic impact of the depth of pathological venous invasion. METHODS: The study included 122 pancreatic cancer patients who underwent curative surgery. All computed tomography scans of the patients were retrospectively interpreted and classified according to the NCCN guidelines, version 1...
April 8, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28407088/borderline-resectable-pancreatic-cancer-conceptual-evolution-and-current-approach-to-image-based-classification
#2
J W Gilbert, B Wolpin, T Clancy, J Wang, H Mamon, A B Shinagare, J Jagannathan, M Rosenthal
BACKGROUND: Diagnostic imaging plays a critical role in the initial diagnosis and therapeutic monitoring of pancreatic adenocarcinoma. Over the past decade, the concept of "borderline resectable" pancreatic cancer has emerged to describe a distinct subset of patients existing along the spectrum from resectable to locally advanced disease for whom a microscopically margin-positive (R1) resection is considered relatively more likely, primarily due to the relationship of the primary tumor with surrounding vasculature...
April 12, 2017: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/28391577/neoadjuvant-treatment-in-pancreatic-cancer-evidence-based-medicine-a-systematic-review-and-meta-analysis
#3
REVIEW
Francesco D'Angelo, Laura Antolino, Alessio Farcomeni, Dario Sirimarco, Andrea Kazemi Nava, Martina De Siena, Niccolò Petrucciani, Giuseppe Nigri, Stefano Valabrega, Paolo Aurello, Giovanni Ramacciato
Neoadjuvant treatment in non-metastatic pancreatic cancer (PaC) has the theoretical advantages of downstaging the tumor, sterilizing any present systemic undetectable disease, selecting patients for surgery and administering therapy to each patient. The aim of this systematic review is to analyze the state of the art on neoadjuvant protocols for non-metastatic PaC. A literature search over the last 10 years was conducted, and papers had to be focused on resectable, borderline resectable (BLR) or locally advanced (LA) histo- or cytologically proven PaC; to be prospective studies or prospectively collected databases; to report percentage of protocol achievement and survival data at least in an intention-to-treat (ITT) analysis...
May 2017: Medical Oncology
https://www.readbyqxmd.com/read/28389044/fdg-pet-predicts-treatment-efficacy-and-surgical-outcome-of-pre-operative-chemoradiation-therapy-for-resectable-and-borderline-resectable-pancreatic-cancer
#4
H Akita, H Takahashi, H Ohigashi, A Tomokuni, S Kobayashi, K Sugimura, N Miyoshi, J-H Moon, M Yasui, T Omori, H Miyata, M Ohue, Y Fujiwara, M Yano, O Ishikawa, M Sakon
BACKGROUND: The efficacy of neoadjuvant chemoradiotherapy (NACRT) for resectable and borderline resectable pancreatic cancer is important for predicting outcomes after radical surgery, but few clinical indicators predict outcome before resection. This study examined the utility of FDG-PET in predicting the efficacy of NACRT and outcome after radical surgery. METHODS: Eighty-three pancreatic cancer patients who underwent FDG-PET before and after NACRT and had positive standard uptake values (SUVs) before NACRT were enrolled in this study...
March 31, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28381388/pancreaticoduodenectomy-for-borderline-resectable-pancreatic-head-cancer-with-a-modified-artery-first-approach-technique
#5
Min Wang, Hang Zhang, Feng Zhu, Feng Peng, Xin Wang, Ming Shen, Ren-Yi Qin
BACKGROUND: The treatment of borderline resectable pancreatic head cancer (BRPHC) is still controversial and challenging. The artery-first approaches are described to be the important options for the early determination. Whether these approaches can achieve an increase R0 rate, better bleeding control and increasing long-term survival for BRPHC are still controversial. We compared a previously reported technique, a modified artery-first approach (MAFA), with conventional techniques for the surgical treatment of BRPHC...
April 2017: Hepatobiliary & Pancreatic Diseases International: HBPD INT
https://www.readbyqxmd.com/read/28378800/phase-ii-study-of-induction-chemotherapy-followed-by-chemoradiotherapy-in-patients-with-borderline-resectable-and-unresectable-locally-advanced-pancreatic-cancer
#6
Michele Fiore, Sara Ramella, Sergio Valeri, Damiano Caputo, Barnaba Floreno, Pasquale Trecca, Luca Eolo Trodella, Lucio Trodella, Rolando Maria D'Angelillo, Roberto Coppola
There is not a clear consensus regarding the optimal treatment of locally advanced pancreatic disease. There is a potential role for neoadjuvant therapy to treat micrometastatic disease with chemotherapy, as well as for the treatment of local disease with radiotherapy. We evaluated the safety and efficacy of induction chemotherapy with oxaliplatin and gemcitabine followed by a high weekly dose of gemcitabine concurrent to radiation therapy in patients with borderline resectable and unresectable locally advanced pancreatic cancer...
April 5, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28378027/a-phase-ii-trial-of-neoadjuvant-chemoradiotherapy-with-intensity-modulated-radiotherapy-combined-with-gemcitabine-and-s-1-for-borderline-resectable-pancreatic-cancer-with-arterial-involvement
#7
Yuichi Nagakawa, Yuichi Hosokawa, Hidetsugu Nakayama, Yatsuka Sahara, Chie Takishita, Tetsushi Nakajima, Yousuke Hijikata, Kazuhiko Kasuya, Kenji Katsumata, Koichi Tokuuye, Akihiko Tsuchida
PURPOSE: Chemoradiotherapy using intensity-modulated radiotherapy (IMRT) is expected to provide a powerful alternative to conventional chemotherapy with a low incidence of adverse events. This study evaluated the efficacy of intensity modulated radiotherapy in combination with gemcitabine and S-1 as neoadjuvant chemoradiotherapy (NACRT) for borderline-resectable pancreatic cancer with arterial involvement (BR-A). METHODS: A total of 27 patients with BR-A were enrolled in this study between February 2012 and September 2015...
April 4, 2017: Cancer Chemotherapy and Pharmacology
https://www.readbyqxmd.com/read/28335780/considerable-interobserver-variation-in-delineation-of-pancreatic-cancer-on-3dct-and-4dct-a-multi-institutional-study
#8
Eva Versteijne, Oliver J Gurney-Champion, Astrid van der Horst, Eelco Lens, M Willemijn Kolff, Jeroen Buijsen, Gati Ebrahimi, Karen J Neelis, Coen R N Rasch, Jaap Stoker, Marcel van Herk, Arjan Bel, Geertjan van Tienhoven
BACKGROUND: The delineation of pancreatic tumors on CT is challenging. In this study, we quantified the interobserver variation for pancreatic tumor delineation on 3DCT as well as on 4DCT. METHODS: Eight observers (radiation oncologists) from six institutions delineated pancreatic tumors of four patients with (borderline) resectable pancreatic cancer. The study consisted of two stages. In the 3DCT-stage, the gross tumor volume (GTV) was delineated on a contrast-enhanced scan...
March 23, 2017: Radiation Oncology
https://www.readbyqxmd.com/read/28280624/the-concept-of-borderline-resectable-pancreatic-cancer-limited-foundations-and-limited-future
#9
John A Windsor, Savio George Barreto
Pancreatic ductal adenocarcinoma (PDAC) is traditionally treated by a surgery-first approach. The development and adoption of the concept of borderline resectable PDAC, which extends the role of surgery, is based on the proposition that neoadjuvant therapy (NAT) will increase the resection rate, margin negative rate and overall survival. There are a number of issues with this concept and a critical review of these suggests that it is based on limited foundations and likely has a limited future.
February 2017: Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/28237643/adjunctive-role-of-preoperative-liver-magnetic-resonance-imaging-for-potentially-resectable-pancreatic-cancer
#10
Hyoung Woo Kim, Jong-Chan Lee, Kyu-Hyun Paik, Jingu Kang, Young Hoon Kim, Yoo-Seok Yoon, Ho-Seong Han, Jaihwan Kim, Jin-Hyeok Hwang
BACKGROUND: The adjunctive role of magnetic resonance imaging of the liver before pancreatic ductal adenocarcinoma has been unclear. We evaluated whether the combination of hepatic magnetic resonance imaging with multidetector computed tomography using a pancreatic protocol (pCT) could help surgeons select appropriate candidates and decrease the risk of early recurrence. METHODS: We retrospectively enrolled 167 patients in whom complete resection was achieved without grossly visible residual tumor; 102 patients underwent pCT alone (CT group) and 65 underwent both hepatic magnetic resonance imaging and pCT (magnetic resonance imaging group)...
February 22, 2017: Surgery
https://www.readbyqxmd.com/read/28179342/phase-i-study-of-nab-paclitaxel-plus-gemcitabine-as-neoadjuvant-therapy-for-borderline-resectable-pancreatic-cancer
#11
Ken-Ichi Okada, Seiko Hirono, Manabu Kawai, Motoki Miyazawa, Atsushi Shimizu, Yuji Kitahata, Masaki Ueno, Shinya Hayami, Hiroki Yamaue
BACKGROUND/AIM: The aim of this study was to investigate the safety and feasibility of neoadjuvant nab-paclitaxel plus gemcitabine therapy for patients with borderline resectable pancreatic carcinoma (BRPC). PATIENTS AND METHODS: The study was a prospective single-center phase I trial for patients with BRPC. The primary endpoint was the toxicity, and secondary endpoints were the resection rate, the R0 resection rate and quality of life (QOL) regarding the peripheral sensory neuropathy (PSN)...
2017: Anticancer Research
https://www.readbyqxmd.com/read/28144084/should-every-patient-with-pancreatic-cancer-receive-perioperative-neoadjuvant-therapy
#12
REVIEW
Ulrich Nitsche, Bo Kong, Alexander Balmert, Helmut Friess, Jörg Kleeff
Pancreatic ductal adenocarcinoma is a highly aggressive disease, and medical as well as surgical therapeutic options are limited. This article reviews stage dependent treatment options, with a special focus on the current controversy of perioperative treatment regimens in initially borderline resectable or locally advanced patients. Neoadjuvant treatment can potentially increase the rate of complete tumor resection and may be more effective than adjuvant systemic therapy. Further, in the case of disease progression during or after neoadjuvant therapy, patients can be spared extensive surgery...
October 2016: Indian Journal of Medical and Paediatric Oncology
https://www.readbyqxmd.com/read/28134673/tolerability-and-long-term-outcomes-of-dose-painted-neoadjuvant-chemoradiation-to-regions-of-vessel-involvement-in-borderline-or-locally-advanced-pancreatic-cancer
#13
Jennifer Y Wo, Andrzej Niemierko, David P Ryan, Lawrence S Blaszkowsky, Jeffrey W Clark, Eunice L Kwak, Keith D Lillemoe, Lorraine N Drapek, Andrew X Zhu, Jill N Allen, Jason E Faris, Janet E Murphy, Ryan Nipp, Carlos Fernandez-Del Castillo, Cristina R Ferrone, Theodore S Hong
PURPOSE: We reviewed our experience involving patients with borderline resectable or locally advanced pancreatic cancer, treated with the dose-painted (DP) boost technique to regions of vessel involvement which preclude upfront surgical resection. We evaluated patient outcomes with respect to tolerability and treatment outcomes. MATERIALS AND METHODS: We retrospectively reviewed 99 patients with borderline resectable (n=25) or locally advanced pancreatic cancer (n=74) treated with DP-neoadjuvant chemoradiation from 2010 to 2015...
January 27, 2017: American Journal of Clinical Oncology
https://www.readbyqxmd.com/read/28133195/-a-case-of-borderline-resectable-pancreatic-cancer-responding-to-preoperative-gem-plus-nab-ptx-combination-chemotherapy
#14
Takuya Fujimoto, Tomio Ueno, Kazuhiko Sakamoto, Satoshi Matsukuma, Hiroto Matsui, Yoshitaro Shindo, Yukio Tokumitsu, Shinsuke Kanekiyo, Michihisa Iida, Yoshihiro Tokuhisa, Nobuaki Suzuki, Shigeru Takeda, Shigefumi Yoshino, Shoichi Hazama, Hiroaki Nagano
We report a case of borderline resectable(BR)pancreatic cancer, which was eligible for R0 resection following preoperative chemotherapy with GEM plus nab-PTX. A 77-year-old woman presented with brown urine and clay-colored stool. After further examination, she was diagnosed with obstructive jaundice due to pancreatic head cancer. Because the tumor was in contact with the region attached to the SMA nerve plexus, she was also diagnosed with BR-A pancreatic cancer. After 6 courses of preoperative GEM plus nab-PTX combination chemotherapy, she underwent subtotal stomach-preservingpancreaticoduodenectomy with SMV resection and right semicircular SMA nerve plexus dissection...
November 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/28133191/-a-case-of-successful-stomach-preserving-pancreaticoduodenectomy-with-celiac-artery-resection-after-neoadjuvant-chemoradiation-therapy-for-pancreatic-cancer-with-hepatic-arterial-variation
#15
Yukie Kyakumoto, Masamichi Mizuma, Tomoya Abe, Tatsuyuki Takadate, Koji Fukase, Hideo Otsuka, Naoaki Sakata, Kei Nakagawa, Takanori Morikawa, Hiroki Hayashi, Takeshi Naitoh, Fuyuhiko Motoi, Atsushi Kanno, Tooru Shimosegawa, Michiaki Unno
Here we report a case of successful stomach-preserving pancreaticoduodenectomy with celiac artery resection for pancreatic cancer with hepatic arterial variation. A 70-year-old woman was referred to our hospital for examination and treatment of pancreatic cancer. A CT scan showed a tumor with suspected portal vein invasion at the body and head of the pancreas, in contact with the common hepatic artery and the splenic artery with 360°involvement. Contact with the celiac artery and left gastric artery was less than1 80°...
November 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/28133097/-a-study-of-gemctabine-plus-nab-paclitaxel-therapy-for-advanced-local-progressive-pancreatic-cancer
#16
Yutaka Itoh, Hiroyuki Saito, Shunsuke Yamagishi, Yuki Suematsu, Miyuki Takahashi, Mao Nakayama, Michiko Fukabori, Akihiko Morita, Kazuhiko Wakabayashi
We studied the significance of gemcitabine plus nab-paclitaxel(GnP)therapy for locally progressive pancreatic cancer. We enrolled 10 patients with local progression without distant metastasis. We used GnP therapy for the ablative borderline resectable(BR)and unresectable(UR)cases based on images that followed NCCN pancreatic cancer treatment guidelines. In 1 case of resectable(R)pancreatic cancer, the tumor was located in the pancreas body but we determined that surgery was impossible because of the underlying disease detected on imaging analysis...
November 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/28105634/does-radiologic-response-correlate-to-pathologic-response-in-patients-undergoing-neoadjuvant-therapy-for-borderline-resectable-pancreatic-malignancy
#17
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...
March 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
#18
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...
March 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
#19
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
#20
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
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