National Cancer Institute®
Last Modified: February 1, 2002
UI - 11558628
AU - Harris J; Bruckner H
TI - Adjuvant and neoadjuvant therapies of pancreatic cancer: a review.
SO - Int J Pancreatol 2001;29(1):1-7
AD - Department of Internal Medicine, Rush Medical College, Chicago, IL 60612, USA.
The survival of patients diagnosed with pancreatic cancer is dismal. Few patients on initial presentation are suitable for surgical resection. This has prompted clinical studies with chemotherapy and/or radiotherapy designed either to increase the number of patients eligible for surgery (neoadjuvant therapy) or to prolong the survival of patients who had undergone surgery (adjuvant therapy). None of these studies may at this time be considered definitive. Wherever possible, patients felt eligible for neoadjuvant or adjuvant therapy should be entered on clinical trials. Where this is not possible, clinicians should exercise their best judgment in offering this type of treatment to pancreatic cancer patients under their care.
UI - 11560155
AU - Crane CH; Janjan NA; Evans DB; Wolff RA; Ballo MT; Milas L; Mason K;
TI - Charnsangavej C; Pisters PW; Lee JE; Lenzi R; Vauthey JN; Wong A; Phan T; Nguyen Q; Abbruzzese JL Toxicity and efficacy of concurrent gemcitabine and radiotherapy for locally advanced pancreatic cancer.
SO - Int J Pancreatol 2001;29(1):9-18
AD - Pancreatic Tumor Study Group, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. email@example.com
BACKGROUND: Gemcitabine and radiotherapy are a potent combination. A clinical assessment of the therapeutic ratio for locally advanced pancreatic cancer patients has not yet been reported. AIM OF STUDY: To assess the toxicity, survival, and pattern of failure of locally advanced pancreatic cancer patients treated with concurrent gemcitabine-based chemoradiation. Patients and Methods. Between the unresectable adenocarcinoma of the pancreas were treated with concurrent gemcitabine and radiotherapy at MDACC. Patients received 250-500 mg/m2 of gemcitabine weekly x7 over 30 min and 30-33 Gy in 10-11 fractions over two weeks to the primary tumor and regional lymphatics. Severe toxicity was defined as admission > 5 d, mucosal ulceration, > 3 dose deletions of gemcitabine or toxicity resulting in surgical intervention or that resulted in death. RESULTS: The median survival was 11 mo. Overall, 37 of 51 patients had objective evidence of local progression. The actuarial rate of local progression rate at 9 mo was 70%. The 9-mo distant metastasis rate was 52%. Tumors > or = 10 cm2 had worse local control, distant control, and overall survival. Six patients underwent pancreaticoduodenectomy after therapy. After review of the imaging, only four of these patients had minimal arterial involvement, one was incorrectly staged, and one had initial inflammatory change on CT that resolved. Twelve of 51 (24%) patients suffered severe acute toxicity, and 17 of 51 (33%) patients were admitted for supportive care. CONCLUSION: Concurrent gemcitabine and radiotherapy can be a very difficult combination to administer safely. Our results do not suggest a prolongation of median survival for patients with localized pancreatic cancer treated with this therapy. It is possible that gemcitabine-based chemoradiation contributes to the margin-negative resectability of a small number of patients with minimal arterial involvement, but this benefit is obscured by the frequent toxicity encountered in most patients. Locally advanced pancreatic cancer patients should continue to be enrolled on prospective studies investigating novel combinations of cytotoxic and/or biologic agents with concurrent radiotherapy.
UI - 11815964
AU - Ryan DP; Kulke MH; Fuchs CS; Grossbard ML; Grossman SR; Morgan JA; Earle
TI - CC; Shivdasani R; Kim H; Mayer RJ; Clark JW A Phase II study of gemcitabine and docetaxel in patients with metastatic pancreatic carcinoma.
SO - Cancer 2002 Jan 1;94(1):97-103
AD - Gastrointestinal Cancer Center, Dana-Farber/Partners Cancer Care, Boston, Massachusetts, USA. firstname.lastname@example.org
BACKGROUND: Patients with metastatic pancreatic carcinoma have a poor survival. Chemotherapy with gemcitabine is the standard first-line treatment. In a Phase II trial at one academic cancer center, the clinical safety and activity of combining gemcitabine and docetaxel were assessed. METHODS: Patients with previously untreated, advanced pancreatic carcinoma were eligible. Bidimensionally measurable disease or evaluable disease with an elevated tumor marker, good performance status, and adequate organ function were required. Patients received docetaxel 60 mg/m(2) on Day 1 and gemcitabine 600 mg/m(2) on Days 1, 8, and 15 every 28 days. Ciprofloxacin was administered on Days 8-18. Dose attenuations were made as indicated for toxicity. Patients were restaged radiographically after every two cycles. RESULTS: Thirty-four patients were enrolled, and 33 patients were evaluable for response. There were 23 men and 10 women among the evaluable patients. The median age was 63 years, and all patients had an Eastern Cooperative Oncology Group performance status of 0 or 1. Three patients had received prior chemoradiation for postresection adjuvant therapy. One hundred forty-six cycles of chemotherapy were administered, and 5 cycles (3%) in 4 patients (12%) were complicated by febrile neutropenia. Twenty percent and 11% of patients on Day 8 and Day 15 doses of gemcitabine, respectively, were omitted for toxicity. The objective response rate was 18%, and the median survival was 8.9 months (95% confidence interval, 5.2-11.2 months). The 1-year survival rate was 29%. CONCLUSIONS: The combination of gemcitabine and docetaxel in patients with advanced pancreatic carcinoma is well tolerated and is associated with moderate activity despite aggressive dose reduction. Whether combination regimens are more effective than single agents in the treatment of patients with pancreatic carcinoma awaits evaluation in randomized studies. Copyright 2002 American Cancer Society.
UI - 10615932
AU - Klinkenbijl JH; Jeekel J; Sahmoud T; van Pel R; Couvreur ML; Veenhof CH;
TI - Arnaud JP; Gonzalez DG; de Wit LT; Hennipman A; Wils J Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group.
SO - Ann Surg 1999 Dec;230(6):776-82; discussion 782-4
AD - Department of Surgery, University Hospital Rotterdam-Dijkzigt, The Netherlands.
OBJECTIVE: The survival benefit of adjuvant radiotherapy and 5-fluorouracil versus observation alone after surgery was investigated in patients with pancreatic head and periampullary cancers. SUMMARY BACKGROUND DATA: A previous study of adjuvant radiotherapy and chemotherapy in these cancers by the Gastrointestinal Tract Cancer Cooperative Group of EORTC has been followed by other studies with conflicting results. METHODS: Eligible patients with T1-2N0-1aM0 pancreatic head or T1-3N0-1aM0 periampullary cancer and histologically proven adenocarcinoma were randomized after resection. RESULTS: Between 1987 and 1995, 218 patients were randomized (108 patients in the observation group, 110 patients in the treatment group). Eleven patients were ineligible (five in the observation group and six in the treatment group). Baseline characteristics were comparable between the two groups. One hundred fourteen patients (55%) had pancreatic cancer (54 in the observation group and 60 in the treatment group). In the treatment arm, 21 patients (20%) received no treatment because of postoperative complications or patient refusal. In the treatment group, only minor toxicity was observed. The median duration of survival was 19.0 months for the observation group and 24.5 months in the treatment group (log-rank, p = 0.208). The 2-year survival estimates were 41% and 51 %, respectively. The results when stratifying for tumor location showed a 2-year survival rate of 26% in the observation group and 34% in the treatment group (log-rank, p = 0.099) in pancreatic head cancer; in periampullary cancer, the 2-year survival rate was 63% in the observation group and 67% in the treatment group (log-rank, p = 0.737). No reduction of locoregional recurrence rates was apparent in the groups. CONCLUSIONS: Adjuvant radiotherapy in combination with 5-fluorouracil is safe and well tolerated. However, the benefit in this study was small; routine use of adjuvant chemoradiotherapy is not warranted as standard treatment in cancer of the head of the pancreas or periampullary region.
UI - 11066157
AU - Evans DB; Wolff RA; Hess KR
TI - Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region.
SO - Ann Surg 2000 Nov;232(5):727
UI - 11677990
AU - Gazzaniga GM; Cappato S; Papadia F; Mori L; Filauro M
TI - D1 versus D2 pancreatoduodenectomy in surgical therapy of pancreatic head cancer.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1471-8
AD - First Department of General Surgery, HPB Unit Galliera Hospital, Via Volta, 8, 161-28 Genova. email@example.com
BACKGROUND/AIMS: The aim of this study was to evaluate the influence of standard pancreatoduodenectomy versus pancreatoduodenectomy with extended lymphadenectomy and the role of adjuvant therapy on survival in patients with ductal adenocarcinoma of the pancreatic head. In addition the problems related to resection are discussed. METHODOLOGY: A total number of 124 pts operated on between 1985 and 1999 were divided into three groups according to our different strategies. Standard resection (D1) was performed on 48 patients (group A), extended resection (D2) on 45 patients (group B) and combined treatment (extended resection plus adjuvant therapy) on 31 patients. The outcome of these three groups was compared with regard to postoperative morbidity and survival. RESULTS: There was no significant difference in terms of survival between group A and B, while adjuvant therapy (group C), achieved statistical significance as factor influencing survival, together with tumor stage. CONCLUSIONS: Our data suggest that no further improvement can be obtained on long-term survival by extended retroperitoneal dissection while chemoradiotherapy showed a doubling of median survival.
UI - 11677991
AU - Yamaguchi K; Kishinaka M; Nagai E; Nakano K; Ohtsuka T; Chijiwa K;
TI - Tanaka M Pancreatoduodenectomy for pancreatic head carcinoma with or without pylorus preservation.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1479-85
AD - Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-82, Japan. firstname.lastname@example.org
BACKGROUND/AIMS: With the concept of less invasive surgery, PpPD (pylorus-preserving pancreatoduodenectomy) has taken the place of conventional Whipple pancreatoduodenectomy (Whipple) as a standard operation for pancreatic head carcinoma. The aim of this paper is to compare early and late postoperative results of PpPD and Whipple for pancreatic head carcinoma. METHODOLOGY: Postoperative clinical follow-up data and outcome of 50 Japanese patients with pancreatic head carcinoma who underwent pancreatoduodenectomy with or without pylorus preservation were reviewed to scrutinize the demerits and merits of the pylorus preservation. RESULTS: Preoperative and postoperative serum chemistry was not different between the two groups. Mean operation time of the Whipple group was 517 minutes, which was significantly shorter than 624 minutes of the PpPD group (P = 0.0006). Cumulative stage was not different between the two groups. Cumulative curability of the PpPD group was superior to the Whipple group; of the 27 patients with Whipple, A in 4, B in 5 and C in 18, while of the 23 patients with PpPD, A in 12, B in 2 and C in 9 (P = 0.0182). Gastric tube was removed on POD 6.0 in the Whipple group, while on POD 39 in the PpPD group (P < 0.0001). Oral intake was started on POD 14.0 in the Whipple group, while on POD 28.3 in the PpPD group (P = 0.0018). Discharge was on POD 57.8 in the Whipple group, while POD 86.9 in the PpPD group (P = 0.0023). At the time of discharge and postoperative 6, 12, and 18 months, body weight loss from the preoperative level was 1kg smaller in the PpPD group than in the Whipple group. 1-year and 3-year survival rates of the Whipple group was 53.8% and 15.8%, while 62.8% and 19.6% of the PpPD group, showing no significant difference. CONCLUSIONS: These data show that delayed gastric emptying is evident in the PpPD group, resulting in longer hospital stay, while long-term body weight loss is smaller in this group. The clinical outcome is similar between the two groups. PpPD can be accepted as a standard operation for pancreatic head carcinoma.
UI - 11677992
AU - Machado MC; Penteado S; Cunha JE; Jukemura J; Herman P; Bacchella T;
TI - Machado MA; Montagnini AL Pancreatic head tumors with portal vein involvement: an alternative surgical approach.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1486-7
AD - Department of Gastroenterology, University of Sao Paulo Medical School, Brazil.
BACKGROUND/AIMS: One of the determining factors for the unresectability of pancreatic head tumors is the involvement of the portal venous system. Recent reports show that the resection of tumors with portal vein involvement has similar results to lesions with same stage without portal vein invasion. The aim of this study is to present a technique that allows the resection of portal vein segments without the use of grafts and with a shorter period of intraoperative venous occlusion. METHODOLOGY: Fifteen patients with pancreatic head tumors and portal vein involvement were submitted to pancreaticoduodenectomy according to this technique. The main feature of the technique is starting the pancreatic dissection at the posterior aspect of the head of the pancreas. The superior mesenteric artery is completely dissected from the pancreatic tissues leaving the section of the pancreas and the resection of the portal vein to the last step. RESULTS: Portal vein flow occlusion did not exceed 10 minutes. There were no major postoperative complications or mortality. CONCLUSIONS: This maneuver allows an easier resection of the mobilized portal vein with a shorter period of venous clamping and reconstruction without the need of venous graft.
UI - 11572580
AU - Martinelli B; Pigni A; Fagnoni E; Chini C; Vallini I; Pinotti G
TI - Personal experience in advanced pancreatic cancer: retrospective analysis on the use of 5-fluorouracil or gemcitabine.
SO - Dig Liver Dis 2001 Aug-Sep;33(6):503
UI - 11787374
AU - Barthet M
TI - [Palliative endoscopic treatment of pancreatic carcinoma]
SO - Gastroenterol Clin Biol 2001 Sep;25 Spec No 2():C15-8
AD - Service de Gastroenterologie, Hopital Nord, Chemin des Bourrely, 13915 Marseille. email@example.com
UI - 11787375
AU - Levy P
TI - [Resectability of pancreatic head adenocarcinoma]
SO - Gastroenterol Clin Biol 2001 Sep;25 Spec No 2():C19-23
AD - Federation medico-chirurgicale d'hepatogastroenterologie, Hopital Beaujon, 92118 Clichy. firstname.lastname@example.org
UI - 11787383
AU - Borie F; Rodier JG; Guillon F; Millat B
TI - [Palliative surgery of pancreatic adenocarcinoma]
SO - Gastroenterol Clin Biol 2001 Sep;25 Spec No 2():C7-14
AD - Service de Chirurgie Digestive, Hopital St Eloi, 34295 Montpellier.
UI - 11740694
AU - Bunk A; Pistorius S; Konopke R; Ockert D; Kuhlisch E; Saeger HD
TI - [The value of colour duplex sonography in the assessment of surgical resectability of pancreatic tumors]
SO - Ultraschall Med 2001 Dec;22(6):265-73
AD - Klinik und Poliklinik fur Viszeral-, Thorax- und Gefasschirurgie, Universitatsklinikum Carl Gustav Carus an der TU Dresden, Germany.
The Value of Colour Duplex Sonography in the Assessment of Surgical Resectability of Pancreatic Tumors. AIM: The aim of this study was to evaluate the assessment by modern colour duplex imaging (CDI) concerning the relation between tumour and vessels including haemodynamic parameters in the main abdominal arteries and the portal system, and to evaluate the influence of these results on surgical decision making. the pancreas were included in a prospective study. Tumour contact to vessels and to the retroperitoneum, data on the flow in the main abdominal arteries and the portal circulation (regional topography) as well as the detection of liver metastases, enlarged lymph nodes and peritoneal carcinomatosis were defined as representing criteria of resectability. The results were compared with the intraoperative situation and with the definite histological findings. RESULTS: In 57 resectable tumours, the portal system was found to be infiltrated by the tumour up to a length of 1.5 cm. The flow velocity reached between 4 and 53 cm/s (mean flow) and 9 to 105 cm/s (maximum flow). Out of 146 pancreatic tumours, 89 were found as being non-resectable. In these cases, the measured parameters differed depending on the degree of tumour infiltration in to the portal circulation. We measured values from 0 to 96 cm/s (mean flow) and from 0 to 201 cm/s (maximum flow) with loss of breath-dependent modulation. The contact area between tumor and portal vessel was longer than 2 cm. Pathological flow in the main abdominal arteries was only found in 2 of 13 cases. The local situation was assessed correctly in 140 out of 146 cases by CDI (sensitivity of 93.0 %, specificity of 97.8 %, positive predictive value of 96.4 %, negative predictive value of 95.6 %). Regarding the complete oncological status (local situation, metastases, lymph node involvement and peritoneal carcinomatosis), a sensitivity of 82.5 % and a specificity of 92.1 % (positive predictive value of 87.0 %, negative predictive value of 89.1 %) was found. CONCLUSION: Modern CDI can reliably assess the resectability of pancreatic tumours by the evaluation of morphological and haemodynamic parameters. There are still difficulties in the assessment of lymph node involvement as well as in the detection of small liver metastases and of peritoneal carcinomatosis without ascites.
UI - 11781662
AU - Wesseling JG; Yamamoto M; Adachi Y; Bosma PJ; van Wijland M; Blackwell
TI - JL; Li H; Reynolds PN; Dmitriev I; Vickers SM; Huibregtse K; Curiel DT Midkine and cyclooxygenase-2 promoters are promising for adenoviral vector gene delivery of pancreatic carcinoma.
SO - Cancer Gene Ther 2001 Dec;8(12):990-6
AD - Department of Experimental Hepatology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
Midkine (MK), a heparin binding growth factor, and cyclooxygenase-2 (COX-2), a key enzyme in the conversion of arachidonic acid to prostaglandin, are both up-regulated at the mRNA or protein level in many human malignant tumors. Here, we investigated the tumor specificity of both MK and COX-2 promoters in human pancreatic cancer, with the aim to improve the selectivity of therapeutic gene expression. We constructed recombinant adenoviral (Ad) vectors containing either the luciferase (Luc) reporter gene under the control of the COX-2 or MK promoter or the herpes simplex virus thymidine kinase (HSV Tk) gene under the control of the COX-2 promoter and compared the expression with the cytomegalovirus (CMV) promoter. AdMKLuc achieved moderate to relatively high activity upon infection to both primary and established pancreatic carcinoma cells. Of the two COX-2 promoter regions (COX-2M and COX-2L), both revealed a high activity in primary pancreatic carcinoma cells, whereas in the established pancreatic carcinoma cell lines, COX-2L has an approximately equal high activity compared to CMV. In addition, both AdCOX-2M Tk and AdCOX-2L Tk induced marked cell death in response to ganciclovir (GCV) in three of four established pancreatic carcinoma cell lines. From these results, and because it has been reported that AdMKTk and AdCOX-2L Tk in combination with GCV did not reveal significant liver toxicity, we conclude that the MK as well as the COX-2 promoters are promising tumor-specific promoters for Ad vector-based gene therapy of pancreatic cancer.
UI - 9424859
AU - Zieniewicz K; Krawczyk M; Nyckowski P; Plaszczyk D
TI - [Pancreatoduodenectomy in treatment of inflammatory tumors of the pancreatic head]
SO - Wiad Lek 1997;50 Suppl 1 Pt 2():127-9
AD - Katedry i Kliniki Chirurgii Ogolnej i Chorob Watroby Akademii Medycznej w Warszawie.
On the basis of their own experience the authors present indications and results of pancreatoduodenectomy for chronic pancreatitis. In a group of 18 patients. With appropriate evaluation of patients, meticulous surgical technique and postoperative care the complications aren't life-threatening. The long-term results are fully satisfactory.
UI - 9383356
AU - Haarmann W; Busing M; Reith HB; Wysocki P; Kozuschek W
TI - The oncological approach to pylorus preserving pancreatoduodenectomy (PPPD) in pancreas malignancies.
SO - Wiad Lek 1997;50 Suppl 1 Pt 2():140-4
AD - Department of Surgery, Ruhr-University Bochum, Knappschafts-Krankenhaus, FRG.
There has been a considerable debate about whether pylorus preservation significantly detracts from the radicality in a palliative procedure where a conventional Whipple operation would have been curative. We know now, that the extending radicality of the Whipple operation does not improve the long-term survival rates. Our results of 127 PPPD and 54 Whipple procedures in pancreas malignancies from 1985 to 1996 showed the nutritional benefits of the PPPD group as compared to the standard Whipple group. 84% (99/121) vs. 24% (13/50) were able to gain postoperatively. The long-term survival rates of both groups and the results in the literature are similar.
UI - 9424864
AU - Plaszczyk D; Zieniewicz K; Krawczyk M; Karwowski A
TI - [Complications after pancreatoduodenectomy in material from clinics in the years 1989-1996]
SO - Wiad Lek 1997;50 Suppl 1 Pt 2():150-3
AD - Katedry i Kliniki Chirurgii Ogolnej i chorob Watroby Akademii Medycznej w Warszawie.
On the basis of 101 pancreatoduodenectomies the authors present early postoperative complications. Cancer was surgical indication for pancreatoduodenectomy in 87 patients and inflammatory tumor of pancreatic head in 14 patients. Complications occurred in 37 cases. The most frequent complications were pancreatic fistula and disturbances of stomach emptying, in most cases treated conservatively. Mortality rate was 6.9%.
UI - 9424865
AU - Knast W; Wierzbicki J; Markocka-Maczka K; Lewandowski A; Wozniak S;
TI - Geneja M [Intraoperative portography in operations for resection of pancreas neoplasms]
SO - Wiad Lek 1997;50 Suppl 1 Pt 2():154-7
AD - Katedry i Kliniki Chirurgii Przewodu Pokarmowego Akademii Medycznej we Wroclawiu.
Since 1993 during pancreatic resection routine intraoperative portography has been employed. Thus we are able to establish infiltration engaging portal vein and its branches. Facilitating decision making about resectability of the tumor. 29 portographies were performed. In eight cases malignant infiltration on portal vein was established. Because of that in seven cases no radical resection was undertaken.
UI - 9424867
AU - Bednarz W; Szydlowski Z; Wojczys R; Woldan J; Forkasiewicz Z; Kornafel P
TI - [Pancreatoduodenectomy by Whipple's method--a method of dealing with the pancreatic stump]
SO - Wiad Lek 1997;50 Suppl 1 Pt 2():162-5
AD - I Katedry i Kliniki Chirurgii Akademii Medycznej we Wroclawiu.
Different methods of pancreatic stump management are possible to perform after pancreaticoduodenectomy. The group of 24 patients after pancreaticoduodenectomy with pancreaticojejunostomy, pancreaticogastrostomy and occlusion of the pancreatic duct by Neopren or Ethiblock were analysed. According to the literature and own results pancreatogastrostomy or occlusion of the pancreatic duct seems to be the safer procedure, but sometimes the choice is made intraoperatively.
UI - 11704461
AU - Hsiung-Stripp DC; McDonough J; Masters HM; Levin WP; Hahn SM; Jones HA;
TI - Metz JM Comparative treatment planning between proton and X-ray therapy in pancreatic cancer.
SO - Med Dosim 2001 Fall;26(3):255-9
AD - Department of Radiation Oncology, University of Pennsylvania, Philadelphia 19104, USA. email@example.com
With the utilization of new biologic agents and experimental chemotherapy in the treatment of pancreatic cancer, the issue of local-regional control will become increasingly important. This study was undertaken to determine the feasibility of dose escalation using proton therapy, as compared to conventional 3-dimensional conformal radiation, by minimizing the dose to normal tissues. The photon treatment plans of 4 patients with unresectable pancreatic cancer treated on a biologic therapy trial were utilized. Each patient was treated using a 3- or 4-field photon plan with 45 Gy to the clinical target volume (CTV), followed by a boost of 14.4 Gy to the gross target volume (GTV). Using a Helax treatment planning system, proton plans were generated to encompass the same CTV and GTV to the same prescribed dose. Dose-volume histograms (DVHs) were generated for the GTV, CTV, spinal cord, liver, and right and left kidneys. Each DVH was compared between the photon and proton plans. Proton plans utilized either a 2- or 3-field technique. Available energies included 130 or 180 MeV. Range modulators and bolus were used as needed to conform to the target volume. With the CTV and GTV receiving the same dose from the proton and photon plans, all individual proton plans were superior to the photon plans in reduction of normal tissue dose. For the 4 patients, the average dose reduction to 50% of the organ at risk was 78% to spinal cord (p = 0.003), 73% to left kidney (p = 0.025), 43% to right kidney (p = 0.059), and 55% to liver (p = 0.061). These comparative treatment plans show proton therapy results in significant reductions of dose to normal tissue compared to conventional photons while treating the same target volumes. This allows for the design of dose-escalation protocols using protons in combination with new biologic therapies and chemotherapy.
UI - 11833306
AU - de Claviere G; Paye F; Fteriche S; Terris B; Belghiti J; Sauvanet A
TI - [Medial pancreatectomy: results of a series of 11 patients]
SO - Ann Chir 2002 Jan;127(1):48-54
AD - Service de chirurgie digestive, hopital Beaujon, 100, boulevard du General-Leclerc, 92110 Clichy, France.
AIM OF THE STUDY: To report a new series of medial pancreatectomy (MP), with analysis of early and long-term results. PATIENTS AND METHODS: From 1990 to 1999, 11 patients (mean age = 53 years, extremes: 28-70)--including 10 non-diabetic--underwent MP for neuroendocrine tumor (n = 5), intraductal papillary mucinous tumor (IPMT) (n = 3), serous cystadenoma, metastasis from renal cell carcinoma, and focal pancreatitis. The procedure included medial resection of variable extent, frozen section, and suture of the cephalic stump. The caudal stump was either anastomosed to the posterior gastric wall (n = 9), or closed when atrophic or very small (n = 2). RESULTS: The mean length of resection was 7 cm (extremes: 4-15). The diagnosis suspected preoperatively was confirmed in 10 cases. In one patient, a suspected adenocarcinoma was actually a focal pancreatitis. No postoperative death occurred. Seven patients experienced complications: one delayed gastric emptying and 6 pancreatic fistulas (54%), including 3 associated with intraabdominal collection. Two patients were reoperated to drain a pancreatic fistula. The mean hospital stay was 14 days (extremes: 10-21) without complications, and 30 days (extremes: 11-90) after complications. After a mean follow-up of 45 months (extremes: 7-130), only one patient initially non-diabetic experienced post-operative diabetes and needs enzyme therapy after a 15 cm-resection for IPMT. No patient developed isolated intrapancreatic recurrence. CONCLUSIONS: MP preserves efficiently pancreatic function and is associated with a low risk of intrapancreatic recurrence. Conversely, MP is associated with an high risk of pancreatic fistula.
UI - 11583197
AU - Ramanathan RK; Cnaan A; Hahn RG; Carbone PP; Haller DG
TI - Phase II trial of dacarbazine (DTIC) in advanced pancreatic islet cell carcinoma. Study of the Eastern Cooperative Oncology Group-E6282.
SO - Ann Oncol 2001 Aug;12(8):1139-43
AD - University of Pittsburgh Cancer Institute, Pennsylvania 15213, USA. firstname.lastname@example.org
BACKGROUND: A phase II study of dacarbazine (DTIC), was conducted to determine the response rate, duration of response, toxicity and overall survival of patients with advanced pancreatic islet cell tumors. PATIENTS AND METHODS: Fifty patients with advanced pancreatic islet cell tumors, having progressive symptoms or evidence of rapidly advancing disease were entered on this study. DTIC was given by IV infusion at a dose of 850 mg/m2, over 60-90 minutes, repeated every four weeks. RESULTS: The response rate was 33% in 42 patients who had measurable tumor, and 34% in the 50 patients (90% confidence interval (90% CI): 23%-47%). The majority of the responses were seen in patients without prior chemotherapy. Median overall survival was 19.3 months. There were two lethal toxicities on the study, one septic shock and one myocardial infarction. Grade 4 toxicities were, hematological (5 patients), sepsis, neurological (depression and paranoid behavior) and bleeding (1 patient each). The most common toxicity was vomiting, grade 3 in 13% of patients. CONCLUSIONS: DTIC has activity in advanced previously untreated pancreatic islet cell tumors.
UI - 11702956
AU - Berlin JD; Rothenberg M
TI - Chemotherapy for resectable and advanced pancreatic cancer.
SO - Oncology (Huntingt) 2001 Oct;15(10):1241-9, 1254; discussion 1254-64
AD - Division of Oncology, Vanderbilt Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, USA. email@example.com
This article will review the pertinent data on the use of chemotherapy for all stages of pancreatic cancer. For patients with metastatic disease, fluorouracil (5-FU) was the standard of care for several decades until a single randomized trial established that gemcitabine (Gemzar) produced a greater clinical benefit response, median survival, and 1-year survival. Among the currently available chemotherapy agents, the taxanes, fluoropyrimidines, and camptothecins are being evaluated in clinical trials alone or in combination with gemcitabine. Newer agents that are not classically cytotoxic are also under investigation and hold promise for the future. In patients with locally advanced unresectable disease, chemotherapy is commonly used to sensitize the cancer to radiation. Current investigations focus on trying to improve chemotherapy as a radiation sensitizer, using, for example, infusional 5-FU and gemcitabine. Early-stage, surgically resectable patients may benefit from the combination of chemotherapy and radiation, although more recent trials conducted in Europe raise some doubt. However, flaws in trial design do not allow firm conclusions to be drawn about the benefits of adjuvant therapy. Both chemotherapy and chemoradiation are under further investigation. Significant improvements in the survival of patients with pancreatic cancer will be achieved as more effective systemic therapies are developed, including agents with novel cellular targets.
UI - 11721113
AU - Srivastava S; Sikora SS; Kumar A; Saxena R; Kapoor VK
TI - Outcome following pancreaticoduodenectomy in patients undergoing preoperative biliary drainage.
SO - Dig Surg 2001;18(5):381-7
AD - Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
OBJECTIVE: To assess the role of preoperative biliary drainage (PBD) in the early outcome following pancreaticoduodenectomy (PD) for periampullary tumors. DESIGN: Retrospective analysis of prospective database. PATIENTS AND METHODS: 121 PDs were performed for periampullary tumors between 1989 and 1998. 54 patients were operated following a PBD (group A) while 67 patients were operated without PBD. 50 patients underwent internal biliary drainage while 4 patients underwent external biliary drainage. Of the 67 patients without PBD, serum bilirubin was >10 mg% in 41 patients (group B) while 26 patients had bilirubin level of <10 mg% (group C). RESULT: Patients were well matched for age, sex distribution, presence of medical risk factors, duration of surgery, operative blood loss and stage of disease. Group A patients had a higher incidence of wound infection (43 vs. 24%; p = 0.03), intra-abdominal abscess (28 vs. 15%; p = 0.06), pancreaticojejunal anastomotic leak (20 vs. 5%; p = 0.01) and overall infective complications (52 vs. 29%; p = 0.01) compared to group B patients, and a higher overall infective complication rate than group C patients (52 vs. 27%; p = 0.02). Group B patients had a higher incidence of intra-abdominal bleeding compared to group A (20 vs. 6%; p = 0.01) and group C patients (20 vs. 4%; p = 0.03). Reoperation rate was significantly higher in group B compared to group A patients (27 vs. 13%; p = 0.04). The mortality rates were not significantly different in the three groups. CONCLUSION: Patients with jaundice (>10 mg%) have a higher risk of bleeding complications while those with PBD have more infective complications. PBD should be judicially employed in selected patients. Copyright 2001 S. Karger AG, Basel
UI - 11747327
AU - Evans JD; Stark A; Johnson CD; Daniel F; Carmichael J; Buckels J; Imrie
TI - CW; Brown P; Neoptolemos JP A phase II trial of marimastat in advanced pancreatic cancer.
SO - Br J Cancer 2001 Dec 14;85(12):1865-70
AD - Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK.
Pancreatic cancer has a poor response to conventional chemotherapy and radiotherapy. Inhibition of matrix metalloproteinase activity involved in tumour invasion and metastases is a novel biological approach for cancer treatment. This multicentre phase II clinical trial assessed marimastat, an oral matrix metalloproteinase inhibitor, in patients with advanced pancreatic cancer. A total of 113 patients received marimastat for 28 days at 100 mg b.d. (n = 9), 25 mg o.d. (n = 90) or 10 mg b.d. (n = 14). Patients with a response to treatment could continue marimastat beyond 28 days. Of 113 patients, 90 (80%) completed the 28-day study and 83 (73%) continued treatment. The principal side effect was arthralgia in 14 (12%) patients at 28 days and 33 (29%) patients over the whole study. There were 31 patients (27%) who required dose modification. Of 76 patients with evaluable CA19-9 levels, 23 (30%) showed no increase or fall in CA19-9. Of 83 patients with radiologically assessable disease, 41 (49%) had stable disease. The median survival was 245 days for those with a stable or falling CA19-9 level 128 days in those with rising CA19-9. The overall survival was 3.8 months. 5.9 months for stage II, 4.7 months for stage III and 3 months for stage IV disease. Of 90 patients, 46 (51%) had stabilization or reduction in pain, mobility and analgesia scores. Further development and clinical evaluation of matrix metalloproteinase inhibitors for the treatment of pancreatic cancer is warranted.
UI - 11748467
AU - Yamada T; Okajima F; Akbar M; Tomura H; Narita T; Yamada T; Ohwada S;
TI - Morishita Y; Kondo Y Cell cycle arrest and the induction of apoptosis in pancreatic cancer cells exposed to adenosine triphosphate in vitro.
SO - Oncol Rep 2002 Jan-Feb;9(1):113-7
AD - Second Department of Surgery, Gunma University, Showamachi, Gunma 371-8511, Japan. firstname.lastname@example.org
Adenosine triphosphate (ATP) has been shown to be an inhibitory or a stimulatory agent for cell growth in various types of cells. Here, we studied the effects of extracellular ATP on two pancreatic cancer cell lines, PK-1 and YAPC established by us. In both cell lines, ATP inhibited cell growth in a time- and dose-dependent manner, whereas the same doses of ATP stimulated DNA synthesis. Flow cytometric analysis of the cells incubated with or without ATP demonstrated the ATP-induced striking increase in cells at S-phase. The same analysis showed also the increase in sub-G0/G1 population in the same analysis and the electrophoretic pattern of DNA showed the occurrence of ATP-induced cell disintegration likely to be apoptosis. We suggest that extracellular ATP is cytotoxic for pancreatic cancer cells because of its induction of cell cycle arrest at S-phase and cell death, possibly apoptosis, overcoming the promotion of the entry into S-phase.
UI - 11775730
AU - Yilmaz S; Kirimlioglu V; Katz DA; Kayaalp C; Caglikulekci M; Ara C
TI - Randomised clinical trial of two bypass operations for unresectable cancer of the pancreatic head.
SO - Eur J Surg 2001 Oct;167(10):770-6
AD - Inonu University Medical School, General Surgery Department, Malatya, Turkey. email@example.com
OBJECTIVE: To compare two different types of prophylactic gastric bypass in patients with cancer of the pancreatic head who were not suitable for curative resection. DESIGN: Prospective study. SETTING: University hospital, Turkey. SUBJECTS: 44 patients with unresectable cancer of the pancreatic head without duodenal obstruction who presented between May patients had an antecolic, isoperistaltic gastrojejunostomy, jejunojejunostomy, and hepaticojejunostomy after cholecystectomy. The remaining 22 had a hepaticojejunostomy and antecolic, antiperistaltic gastrojejunostomy procedure after cholecystectomy. MAIN OUTCOME MEASURES: Mortality, morbidity, postoperative course, and survival. RESULTS: There were no significant differences between the groups in the incidence of postoperative complications, time until restoration of oral diet, relaparotomy rate, late upper gastrointestinal bleeding, mortality, duration of hospital stay, and survival. The isoperistaltic operation took significantly longer than the antiperistaltic operation (p < 0.001) and there was less delayed gastric emptying in the antiperistaltic group but not significantly so. Both operations caused a significant lengthening in the postoperative gastric emptying time (p = 0.04 and p = 0.01, respectively). CONCLUSION: Both procedures are suitable for patients with unresectable carcinoma of the pancreatic head without impending duodenal obstruction. There was a trend towards better clinical results with the isoperistaltic procedure.
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