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Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Pancreatic Cancer - July 2002
National Cancer Institute®
Last Modified: July 1, 2002
- Implication of thymidylate synthase in the outcome of patients with invasive ductal carcinoma of the pancreas and efficacy of adjuvant
- Dual-phase versus single-phase helical CT to detect and assess resectability of pancreatic carcinoma.
- [Neuroendocrine tumors of the digestive system]
- Complications of pancreatic cancer resection.
- [How I treat ... An advanced pancreatic cancer]
- [Guidelines for management of patients with pancreatic cancer]
- [Diagnosis and therapy of pancreatic tumors]
- [Guideline for proper use of antineoplastic agents. Cancer of the digestive system--malignant cancers (stomach, colonic, and pancreatic
- Pancreatectomy combined with superior mesenteric-portal vein resection for adenocarcinoma in pancreas.
- Blind distal pancreatectomy for occult insulinoma, an inadvisable procedure.
- Intraoperative molecular detection of circulating tumor cells by reverse transcription-polymerase chain reaction in patients with
- [Surgical therapy of locally advanced and primary inoperable pancreatic carcinoma after neoadjuvant preoperative radiochemotherapy]
- Cystic tumours of the pancreas: a review.
- Phase II study of uracil-tegafur in patients with metastatic pancreatic cancer.
- Phase II study of docetaxel in patients with pancreatic cancer previously untreated with cytotoxic chemotherapy.
- A nitroimidazole derivative, PR-350, enhances the killing of pancreatic cancer cells exposed to high-dose irradiation under hypoxia.
- Pancreatic cancer.
- [Application of hemopoietic cells of embryonal human liver in treatment of pancreatic head cancer complicated by obturating jaundice]
- High-dose intraoperative radiotherapy for unresectable pancreatic cancer.
- Solid-pseudopapillary tumor of the pancreas: a surgical enigma?
- Present and future treatment of pancreatic cancer.
- [Cephalic duodenopancreatectomy with pyloric preservation in the treatment of pancreatic cancer]
- [Surgical treatment of malignant tumors in the biliopancreatoduodenal zone]
- A phase I trial of weekly gemcitabine and concurrent radiotherapy in patients with locally advanced pancreatic cancer.
- Pancreatoduodenectomy for pancreatic adenocarcinoma: triumph, triumphalism, or transition?
Table of Contents
1
UI - 11914644
AU - Takamura M; Nio Y; Yamasawa K; Dong M; Yamaguchi K; Itakura M
TI -
Implication of thymidylate synthase in the outcome of patients with
invasive ductal carcinoma of the pancreas and efficacy of adjuvant
chemotherapy using 5-fluorouracil or its derivatives.
SO - Anticancer Drugs 2002 Jan;13(1):75-85
AD - First Department of Surgery, Shimane Medical University, Izumo 693-8501,
Japan.
Thymidine synthase (TS) is a key enzyme in the synthesis of pyrimidine
in the de novo pathway of DNA synthesis and a major target of
5-fluorouracil (5-FU), but the implications of TS regarding human
pancreatic cancer have not been reported. We assessed the expression of
TS in invasive ductal carcinoma (IDC) of the pancreas by immunostaining
and evaluated its clinicopathological significance, especially its
implications regarding the efficacy of chemotherapy with 5-FU or its
derivatives. The expression of TS in the nuclei of pancreatic cancer
cells in 72 primary lesions of resectable IDC and 30 distant metastases
of unresectable IDC was examined by immunostaining using anti-TS
polyclonal antibody and immunoreactivity was classified into three
categories: negative (-), low (+) and high (2+). High TS
immunoreactivity was detected in 43% (31 of 72) of the primary lesions
of the resectable IDCs and in 47% (18 of 38) of the metastatic lesions
of the unresectable IDCs. The high TS in primary lesions showed a
significantly inverse correlation with the level of nodal involvement.
High TS immunoreactivity had a significant influence on the outcome of
patients with resectable IDC and the rate of survival of the high TS
immunoreactivity group was significantly higher than that of the
negative or low reactivity groups, although high TS immunoreactivity did
not have a significant influence on survival of the patients with
unresectable IDC. The implications of TS immunoreactivity regarding the
efficacy of 5-FU-based adjuvant chemotherapy (ACT) was also assessed.
The high TS immunoreactivity group showed significantly better survival
in both the patients who received ACT and those who were treated by
surgery alone, in the resectable IDC among patients with resectable IDC.
In cases of unresectable IDC, there were no differences in survival
between the high and low TS groups among the patients who received ACT
and those who were treated by surgery. In conclusion, high TS
immunoreactivity was found to be cogent in predicting the prognosis of
patients with pancreatic IDC, but its implications regarding the
efficacy of 5-FU-based ACT are still unclear.
2
UI - 12034622
AU - Imbriaco M; Megibow AJ; Camera L; Pace L; Mainenti PP; Romano M; Selva
TI -
G; Salvatore M
Dual-phase versus single-phase helical CT to detect and assess
resectability of pancreatic carcinoma.
SO - AJR Am J Roentgenol 2002 Jun;178(6):1473-9
AD - Department of Radiology, University "Federico II," Via Pansini 5, 80131
Napoli, Italy.
OBJECTIVE: The aim of this study was to compare dual-phase and
single-phase helical CT for the detection and assessment of
resectability of pancreatic adenocarcinoma. SUBJECTS AND METHODS: We
studied 60 patients (31 men, 29 women; age range, 31-84 years; mean age,
62 years) with suspected pancreatic malignancy. Patients were randomly
assigned to one of two groups. For group A (n = 30), unenhanced scans
through the liver and pancreas were followed by two separate
acquisitions (dual-phase) at 20-25 and at 60-80 sec after IV contrast
administration. For group B (n = 30), unenhanced scans were followed by
one set of scans (single-phase) acquired caudocranially (from the
inferior hepatic margin to the diaphragm) starting 50 sec after IV
contrast administration. Two observers independently scored images for
the presence of tumor and for assessment of tumor resectability.
RESULTS: Comparison of dual-phase versus single-phase helical CT for
tumor detection showed a diagnostic accuracy for observer 1 of 87% and
90%, respectively, and for observer 2, of 90% and 87%, respectively. For
both helical CT techniques, the overall agreement between the two
observers was 83% (kappa = 0.73 +/- 0.03) for single-phase helical CT
and 90% (kappa = 0.89 +/- 0.03) for dual-phase helical CT. The
assessment of resectability was affected by the low number of resectable
tumors (n = 8). CONCLUSION: Single-phase helical CT is effective for the
diagnosis and assessment of resectability of patients with suspected
pancreatic carcinoma. Advantages are the lower radiation dose and fewer
images to film and store.
3
UI - 12063866
AU - Pronai L; Racz K; Tulassay Z
TI -
[Neuroendocrine tumors of the digestive system]
SO - Orv Hetil 2002 May 12;143(19 Suppl):1081-6
AD - Altalanos Orvostudomanyi Kar, II. Belgyogyaszati Klinika, Semmelweis
Egyetem, Budapest.
Despite their rare occurrence, gastroenteropancreatic neuroendocrine
tumors have been in the centre of interest because of the wide scale and
variability of clinical signs and symptoms associated with oversecretion
of different hormones. In the present review the authors summarize
epidemiological data, pathologic findings, clinical symptoms, as well as
diagnostic and therapeutic methods presently available for the
management of patients with gastroenteropancreatic neuroendocrine
tumors. In addition to surgical treatment and receptor-specific
radionuclide therapy used in cases with surgically noncurable tumors,
the therapeutic use of somatostatin analogues in recent years has
resulted an important advance in the management of patients with these
tumors. Somatostatin analogues alone or in combination with other
pharmacological therapies may be used effectively for elimination of
symptoms of hormonal oversection and, in a number of cases, for
diminishing tumor progression.
4
UI - 11979003
AU - Halloran CM; Ghaneh P; Bosonnet L; Hartley MN; Sutton R; Neoptolemos JP
TI -
Complications of pancreatic cancer resection.
SO - Dig Surg 2002;19(2):138-46
AD - Department of Surgery, Royal Liverpool University Hospital, UK.
Pancreatic cancer is a common cause of cancer death in the developed
world. Currently, resection is the only chance of long-term survival.
The post-operative mortality in nonspecialist centres often exceeds 20%
but is around 6% or less in specialist centres. The overall complication
rate even in specialist centres is 18-54%. An analysis of eleven large
series of pancreatic resections shows an incidence of common
complications of 10.4% for fistula, 9.9% for delayed gastric emptying,
4.8% for bleeding, 4.8% for wound infection and 3.8% for intra-abdominal
abscess. The median hospital stay is 13-18 days in different series. The
re-operation rate varies from 4 to 9% with a mortality rate of 23 to
67%. Major complications are a significant factor in post-operative
mortality, especially if they require re-operation. The use of
octreotide or somatostatin to prevent complications is supported by
several multicentre, double-blind, randomized controlled trials. The
best way to improve outcome is to concentrate pancreatic cancer care in
regional specialist centres. Copyright 2002 S. Karger AG, Basel
5
UI - 12014258
AU - Polus M; Jerusalem G; Sautois B; Silvestre RM; Fillet G
TI -
[How I treat ... An advanced pancreatic cancer]
SO - Rev Med Liege 2002 Mar;57(3):131-4
AD - Service d'Oncologie medicale, CHU, Sart Tilman.
Median survival of advanced pancreatic cancer is about three months.
Unfortunately, chemotherapy is not a curative approach. Chemotherapy
improves the quality of life and overall survival compared to best
supportive care. Nevertheless, as the overall survival remains
disappointing, clinical research must ongoing to define better treatment
regimen.
6
UI - 12025194
AU - Ihse I; Permert J; Andersson R; Borgstrom A; Dawiskiba S; Enander LK;
TI -
Glimelius B; Hafstrom L; Haglund U; Larsson J; Lindell G; Olmarker A;
von Rosen A; Svanvik J; Svensson JO; Thune A; Tranberg KG
[Guidelines for management of patients with pancreatic cancer]
SO - Lakartidningen 2002 Apr 11;99(15):1676-80, 1683-5
AD - Kirurgiska kliniken, Universitetssjukhuset, Lund. ingemar.ihse@kir.lu.se
The incidence of pancreatic cancer has fallen during the last ten years
in Sweden. Early signs and symptoms of the disease are still
undiscovered and when diagnosis is made the disease is incurable in most
patients. Transabdominal ultrasonography is the first-line imaging test
followed by spiral computed tomography (CT) and magnetic resonance
imaging (MRI) if required for definite diagnosis. Spiral CT is also the
imaging test of choice for assessment of resectability of the tumor.
Surgical removal of the tumor is the only chance of cure. Markedly
improved hospital mortality after pancreaticoduodenectomy is reported
and an association between hospital volume and outcome of the operation
has been established. Longterm survival after attempted curative
resection continues to be dismal, however. Adjuvant treatment should not
be given outside clinical studies. Palliative treatment has improved
thanks to progress in the field of endoscopy, interventional radiology
and in management of pain and nutrition. Palliative chemotherapy should
only be given selectively outside clinical studies. Radiotherapy has no
proven effects on survival. Special pancreatic cancer treatment teams
with catchment areas of 2-4 million inhabitants are recommended by
international authorities.
7
UI - 12061184
AU - Soumarova R; Perkova H; Seneklova Z; Horova H; Ruzickova J; Karasek P
TI -
[Diagnosis and therapy of pancreatic tumors]
SO - Vnitr Lek 2002 Apr;48(4):332-43
AD - Oddeleni radiacni onkologie Masarykova onkologickeho ustavu, Brno.
Pancreatic tumours belong among oncological diseases with a very poor
prognosis. The total five-year survival is 1-2%. Surgical resection with
a curative intention increases the probability of five-year survival to
10-20%. However only some 10% tumours are diagnosed in the resectable
stage. The reason is the low specificity of initial symptoms. Earlier
diagnosis and improvement of survival could be promoted by improvement
of imaging methods and endoscopic techniques. Improvement of therapeutic
results in selected indications can be achieved by adjuvant treatment
(chemotherapy, radiotherapy, possibly their combination). Treatment of
inoperable stages of the disease is focused in particular on improvement
of the quality of the patient's life. Its aim is specially to mitigate
pain and reduce the consumption of analgesics, to ensure bile derivation
or release the passage through the digestive tract. This can lead also
to improvement of the patient's general condition. Despite advances in
molecular biology of pancreatic cancer the results of systemic treatment
remain unsatisfactory in advanced tumours. Nevertheless therapeutic
nihilism must not prevail nowadays. It is necessary to use new findings
in diagnosis and therapy. Patients with this disease should be included
in clinical trials investigating optimal therapeutic procedures.
8
UI - 12109442
AU - Sasaki T; Maeda Y; Mukoyama O
TI -
[Guideline for proper use of antineoplastic agents. Cancer of the
digestive system--malignant cancers (stomach, colonic, and pancreatic
cancers)]
SO - Gan To Kagaku Ryoho 2002 Jun;29(6):1008-14
9
UI - 11571964
AU - Shibata C; Kobari M; Tsuchiya T; Arai K; Anzai R; Takahashi M; Uzuki M;
TI -
Sawai T; Yamazaki T
Pancreatectomy combined with superior mesenteric-portal vein resection
for adenocarcinoma in pancreas.
SO - World J Surg 2001 Aug;25(8):1002-5
AD - Department of Surgery, Sendai City Medical Center, 5-22-1 Tsurugaya,
Miyagina-ku, Sendai 983-0824, Japan.
The aims of this study were to investigate morbidity, mortality, and
survival of patients with ductal adenocarcinoma of the pancreas who
underwent pancreatectomy without (group 1) or with (group 2) en bloc
portal vein resection and to study the degree of carcinoma invasion of
the portal vein in group 2. The medical records of 46 and 28 patients in
groups 1 and 2, respectively, were reviewed. In addition, the degree of
invasion of the wall of the portal vein was categorized histologically
into three types: type I, transmural invasion involving the intima; type
II, invasion of the wall of the vein without intimal involvement; and
type III, compression of the wall of the vein by surrounding carcinoma
without true invasion. The morbidity and mortality in group 1 (26% and
4%) were not different from those in group 2 (32% and 4%). Similarly,
there was no difference in survival between the two groups. Survival
tended to vary directly with the depth of invasion of the wall of the
portal vein: type I 6.8 +/- 1.9 months; type II 15.3 +/- 6.4 months;
type III 20.6 +/- 13.0 months. These findings suggest that en bloc
resection of the pancreas and the portal vein does not increase
mortality and morbidity after pancreatectomy; survival after en bloc
resection was similar to that of patients not requiring portal vein
resection. Combined resection of the pancreas with the portal vein could
be an option in the treatment of pancreatic cancer with direct invasion
of the portal vein.
10
UI - 12081066
AU - Hirshberg B; Libutti SK; Alexander HR; Bartlett DL; Cochran C; Livi A;
TI -
Chang R; Shawker T; Skarulis MC; Gorden P
Blind distal pancreatectomy for occult insulinoma, an inadvisable
procedure.
SO - J Am Coll Surg 2002 Jun;194(6):761-4
AD - Division of Intramural Research, National Institute of Diabetes,
Digestive and Kidney Diseases, National Institutes of Health, Bethesda,
MD, USA.
BACKGROUND: Fasting hypoglycemia with neuroglycopenic symptoms corrected
by administration of glucose are the hallmarks for the diagnosis of
insulinoma. Surgical resection is the treatment of choice for
insulinomas, but localization of these lesions can be challenging. Blind
distal pancreatectomy has been advocated for occult insulinomas not
detected on imaging studies or during abdominal exploration. With the
advent of newer localization techniques, we challenge the wisdom of this
approach. STUDY DESIGN: The records of patients (multiple endocrine
neoplasia excluded) with pathologically proved insulinoma who were
screened at our institution or referred to us after a failed blind
distal pancreatectomy were reviewed. All records included patient
history and results of physical examination and routine blood and urine
tests. The diagnosis of insulinoma was confirmed during a supervised
fast. Patients with biochemically proved insulinoma underwent
localization studies and operation. Studies included CT scans, MRI,
transabdominal ultrasound, intraoperative ultrasonography, angiography
(more recently, Ca++-stimulated arteriography), and venous sampling.
RESULTS: From 1970 to 2000, 99 patients (34 men, 65 women; mean age 43
years) underwent operation. All patients with benign tumors (92) were
cured after operation. Seventeen patients were referred to the NIH after
a failed blind distal pancreatectomy. Of these, 5 were diagnosed as
having factitious hypoglycemia. In the other 12 patients a tumor was
localized in the pancreatic head. Two patients incorrectly diagnosed
with nesidioblastosis after initial surgery were subsequently cured by
resection of an insulinoma. CONCLUSIONS: The use of preoperative imaging
studies, most notably Ca++-stimulated arteriography, and intraoperative
ultrasonography permits detection of virtually all insulinomas,
including reopcrated cases. When a tumor is not detected, the procedure
should be terminated and the patient referred to a center capable of
performing advanced preoperative and intraoperative localization
techniques. With the preoperative and intraoperative imaging strategies
currently available, the use of blind distal pancreatectomy for occult
insulinoma should be abolished.
11
UI - 11986188
AU - Uchikura K; Takao S; Nakajo A; Miyazono F; Nakashima S; Tokuda K;
TI -
Matsumoto M; Shinchi H; Natsugoe S; Aikou T
Intraoperative molecular detection of circulating tumor cells by reverse
transcription-polymerase chain reaction in patients with
biliary-pancreatic cancer is associated with hematogenous metastasis.
SO - Ann Surg Oncol 2002 May;9(4):364-70
AD - First Department of Surgery, Kagoshima University School of Medicine,
Kagoshima, Japan.
BACKGROUND: Circulating tumor cells in the blood were frequently
detected by reverse transcription-polymerase chain reaction during
operation in patients with biliary-pancreatic cancer. We investigated
the relationship between circulating tumor cells during operation and
hematogenous metastases. METHODS: Blood samples from 67 patients with
biliary-pancreatic cancer were obtained from the portal vein, peripheral
artery, and superior vena cava during operation. After total RNA was
extracted from each blood sample, carcinoembryonic antigen
(CEA)-specific reverse transcription-polymerase chain reaction was
performed. RESULTS: Intraoperative CEA-messenger RNA (mRNA) expression
was detected in the blood of 32 (47.8%) of 67 patients with
biliary-pancreatic cancer, although it was not detected in the blood
obtained from 20 healthy volunteers or 15 patients with benign disease
of the biliary pancreas. The incidence (37.5%) of hematogenous
metastases after surgery in the CEA-mRNA-positive group (n = 32) was
significantly higher than that (11.4%) in the negative group (n = 35; P
=.01). In stage I, II, and III patients, survival of the
CEA-mRNA-positive group was significantly worse compared with that of
negative group (P =.03). CONCLUSIONS: Intraoperative molecular detection
of circulating tumor cells in patients with biliary-pancreatic cancer
relates to a high risk of hematogenous metastasis and is associated with
unfavorable prognosis even after curative resection.
12
UI - 11974476
AU - Rau HG; Wichmann MW; Wilkowski R; Heinemann V; Sackmann M; Helmberger T;
TI -
Duhmke E; Schildberg FW
[Surgical therapy of locally advanced and primary inoperable pancreatic
carcinoma after neoadjuvant preoperative radiochemotherapy]
SO - Chirurg 2002 Feb;73(2):132-7
AD - Chirurgische Klinik und Poliklinik, Ludwig-Maximilian-Universitat,
Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munchen.
horst.rau@gch.med.uni-muenchen.de
INTRODUCTION: So far, surgery represents the only prospect for cure in
patients with pancreatic cancer. Most patients, however, present with
locally advanced pancreatic cancer at primary diagnosis. Recently, novel
therapeutic regimens with preoperative radiochemotherapy have been
developed that may improve long-term survival and resectability rates of
patients with locally advanced pancreatic cancer. METHODS: This
feasibility study evaluates the preliminary results of neoadjuvant
therapy with gemcitabine and 5-fluorouracil (5-FU) or cisplatin.
Twenty-six patients suffering from locally advanced pancreatic cancer
were considered for preoperative radiochemotherapy. They received
radiation (45 Gy) and chemotherapy with simultaneous or sequential
gemcitabine and 5-FU (n = 15) or gemcitabine and cisplatin (n = 11)
administration prior to surgical resection. RESULTS: Mean patient age
was 62.4 +/- 2.6 years and 62% (n = 16) were male. The response rate was
69%, and 11 patients underwent curative surgical resection of the
pancreatic cancer. Nine Whipple procedures and two complete
pancreatectomies were carried out. In five patients a total of eight
surgical complications were observed. Median overall survival was 9.8
months after primary cancer diagnosis (mean 12.0 +/- 1.2). During
follow-up no local recurrent disease was detected. CONCLUSIONS: Our
findings lead us to conclude that preoperative chemoradiation with 45
Gy, gemcitabine and 5-FU or cisplatin is a powerful therapeutic tool in
patients with locally advanced non-resectable pancreatic cancer. Major
resections, including vascular reconstructions, are nonetheless
associated with increased mortality. Preoperative chemoradiation
contributes to improved survival in patients with primary non-resectable
pancreatic cancer.
13
UI - 11723890
AU - Falconi M; Bassi C; Dervenis C; Bettini R; Salvia R; Carbognin G;
TI -
Capelli P; Pederzoli P
Cystic tumours of the pancreas: a review.
SO - Chir Ital 2001 Sep-Oct;53(5):595-608
AD - U.O. Endocrinochirurgia, Universita di Verona, Verona.
The detection of a cystic tumour of the pancreas is a challenge which
puts not only the surgeon's knowledge and expertise to the test, but
also those of the team of radiologists and pathologists with whom he
works. The diagnosis of a suspected pancreatic cystic tumour is
morphological and is based on modern imaging techniques and, in the case
of intraductal papillary mucinous tumours, on endoscopic findings. In
the search for the correct preoperative diagnosis, however, it is of
fundamental importance to bear in mind the limitations of the various
instrumental investigations, and particularly those of fine-needle
aspiration cytology. In this light the main morphological and
clinicopathological features of serous cystadenomas, mucinous adenomas
and adenocarcinomas, intraductal papillary mucinous tumours and
papillary cystic and solid tumours are analysed as well as the surgical
indications. In fact only the surgeon, on the basis of his knowledge of
the patient's medical history and symptoms, will be in a position to
determine to which nosological "cystic" entity the morphological
findings described belong. A deeper knowledge of the natural history of
each of these cystic tumours will help the surgeon formulate the most
appropriate treatment indication. Providing the patient's condition
fulfills the necessary operability criteria, resection will be mandatory
whenever there exists a doubt that the tumour may be malignant or
whenever its natural history suggests a malignant potential.
14
UI - 12065869
AU - Ueno H; Okada S; Okusaka T; Ikeda M; Kuriyama H
TI -
Phase II study of uracil-tegafur in patients with metastatic pancreatic
cancer.
SO - Oncology 2002;62(3):223-7
AD - Hepatobiliary and Pancreatic Oncology Division, National Cancer Center
Hospital, Tokyo, Japan. hiueno@ncc.go.jp
OBJECTIVE: Uracil-tegafur (UFT) has been reported to have a broad
anti-tumor activity in a variety of malignancies including colorectal
cancer and breast cancer. However, its activity in pancreatic cancer has
not been fully evaluated. The aim of the present study was to evaluate
the anti-tumor activity and toxicity of UFT in patients with metastatic
pancreatic cancer. METHODS: All patients were required to have a
pathologic diagnosis of pancreatic adenocarcinoma with measurable
metastatic lesions, and no prior chemotherapy. A dose of 360 mg/m2/day
of UFT was administered orally until the appearance of disease
progression or unacceptable toxicity. RESULTS: Twenty-two patients were
entered into this study. Of 21 patients evaluable for response, no
patient achieved an objective tumor response; one showed no change, and
the remaining 20 showed progressive disease. The median survival time
for all patients was 4.2 (range: 0.9-9.0) months. The most common
toxicities were nausea/vomiting and anorexia. Five patients (23%) had to
discontinue UFT treatment because of gastrointestinal toxicity.
CONCLUSION: This schedule of UFT did not demonstrate a significant
anti-tumor activity against metastatic pancreatic cancer. Copyright 2002
S. Karger AG, Basel
15
UI - 12094541
AU - Lenzi R; Yalcin S; Evans DB; Abbruzzese JL
TI -
Phase II study of docetaxel in patients with pancreatic cancer
previously untreated with cytotoxic chemotherapy.
SO - Cancer Invest 2002;20(4):464-72
AD - Department of Gastrointestinal Medical Oncology and Digestive Diseases,
University of Texas M. D. Anderson Cancer Center, 1515 Holcombe
Boulevard, Box 426, Houston, TX 77030, USA. rlenzi@mdanderson.org
In this study, we estimated the response rate, duration of response, and
type, severity and reversibility of toxicities in patients with Stage IV
adenocarcinoma of the pancreas treated with docetaxel. Twenty-one
patients with locally advanced or metastatic pancreatic cancer,
previously untreated or treated with surgery or radiation alone, were
treated with 100 mg/m2 docetaxel as a 1 hr infusion once every 21 days.
All the patients were pretreated with dexamethasone and diphenhydramine.
Twenty patients were assessable for both response and toxicity. One
patient was assessable for toxicity alone. However, all the patients
were assessed for survival. The major side effect of the drug was
neutropenia, which required a dose reduction to 75 mg/m2 in
approximately half of the patients. Nine patients were hospitalized with
neutropenic fever. Fluid retention was not a significant problem. One
patient had a partial response lasting for 21 weeks and 7 patients had
stable disease. The remaining patients had progressive disease. The
median survival for all the patients was 5.9 months. Docetaxel as a
single agent showed limited activity against adenocarcinoma of the
pancreas. Since the completion of this study, molecular predictors of in
vitro response to docetaxel have been described. Confirmation of the
clinical relevance of such predictors in humans could allow for the
identification of a subgroup of patients with a higher rate of response
to docetaxel.
16
UI - 12056329
AU - Mizumoto K; Qian LW; Zhang L; Nagai E; Kura S; Tanaka M
TI -
A nitroimidazole derivative, PR-350, enhances the killing of pancreatic
cancer cells exposed to high-dose irradiation under hypoxia.
SO - J Radiat Res (Tokyo) 2002 Mar;43(1):43-51
AD - Department of Surgery and Oncology, Graduate School of Medical Sciences,
Kyushu University, Fukuoka 812-8582, Japan.
mizumoto@mailserver,med.kyushu-u.ac.jp
The radiosensitizing effects of PR-350, a nitroimidazole derivative,
were examined concerning the cell killing of human pancreatic cancer
cell lines exposed to high doses of gamma-ray irradiation in vitro. The
percentages of dead cells were analyzed with a multiwell plate reader to
measure the fluorescence intensity of propidium iodide before and after
a digitonin treatment. The sensitizing effect of PR-350 on cell killing
by high-dose irradiation was confirmed by time-course, dose-dependency,
and microscopic observations. In five of seven pancreatic cancer cell
lines in which the number of dead cells was determined 5 days after 30
Gy irradiation in the presence of PR-350, the number was significantly
increased under hypoxic conditions, but not under aerobic conditions.
The selective radiosensitive effect of PR-350 on hypoxic cells was also
confirmed by flow cytometry. The results indicate that PR-350 can
enhance the killing of pancreatic cancer cells by high-dose irradiation
under hypoxia, which supports its clinical radiosensitizing effects when
administered during intraoperative irradiation to pancreatic cancer.
17
UI - 12057145
AU - Cohen SJ; Pinover WH; Watson JC; Meropol NJ
TI -
Pancreatic cancer.
SO - Curr Treat Options Oncol 2000 Dec;1(5):375-86
AD - Department of Medical Oncology, Fox Chase Cancer Center, 7701 Burholme
Avenue, Philadelphia, PA 19111, USA.
Optimal therapy for pancreatic adenocarcinoma requires surgical removal
with tumor-free margins. Superior outcomes have been reported for
high-volume centers incorporating a multidisciplinary approach.
Postoperative ("adjuvant") chemotherapy and radiation should be
considered in patients with successfully resected primary tumors.
Combined modality treatment with chemotherapy and radiation should be
considered for locally advanced, unresectable tumors. Gemcitabine can
provide symptom relief and a modest improvement in survival for patients
with metastatic disease. Strict attention to relief of symptoms such as
pain, depression, anorexia/cachexia, and jaundice is essential in all
patients with pancreatic cancer. All patients with pancreatic cancer
should be encouraged to enter clinical trials of new therapies, given
that long-term survival for all stages remains poor.
18
UI - 11944235
AU - Smikodub AI
TI -
[Application of hemopoietic cells of embryonal human liver in treatment
of pancreatic head cancer complicated by obturating jaundice]
SO - Klin Khir 2001 Nov;(11):14-7
In 30 patients with pancreatic head cancer after surgical treatment of
biliary ducts obstructions using biliodigestive shunting method the
suspensions, containing stem cells of embryonal liver, were
transplanted. The hematological and immunological indexes improvement
was noted. After transplantation performance several courses of
chemotherapy were conducted, promoting elongation of average life span
by 50%.
19
UI - 12118565
AU - Shibamoto Y; Manabe T; Ohshio G; Sasai K; Nishimura Y; Imamura M;
TI -
Takahashi M; Abe M
High-dose intraoperative radiotherapy for unresectable pancreatic
cancer.
SO - Int J Radiat Oncol Biol Phys 1996 Jan 1;34(1):57-63
AD - Department of Radiology, Faculty of Medicine, Chest Disease Research
Institute, Kyoto University, Japan.
PURPOSE: The results of high-dose intraoperative radiotherapy (IORT)
and/or external beam radiotherapy (EBRT) for unresectable pancreatic
cancer were analyzed to evaluate the possible advantages of IORT in
combination with EBRT. METHODS AND MATERIALS: Between 1983 and 1993, 115
patients with unresectable adenocarcinoma of the pancreas (53 with
non-Stage IV disease and 62 with Stage IV disease) were treated with
EBRT + IORT (55 patients), EBRT alone (44 patients), or IORT alone (16
patients). In non-Stage IV patients, the use of EBRT alone was due to
the unavailability of IORT and the use of IORT alone was due to refusal
of EBRT. The IORT dose was 30-33 Gy and the EBRT dose was 40-60 Gy. A
historical control group comprised of 101 patients undergoing palliative
surgery alone was also analyzed. RESULTS: Both non-Stage IV and Stage IV
patients receiving EBRT with or without IORT had a better prognosis than
the nonirradiated historical controls. Among non-Stage IV patients, the
median survival of the EBRT + IORT group (8.5 months) and the EBRT group
(8 months) was similar, although survival from 12 to 18 months was
higher in the former group (38% vs. 10% at 12 months, p = 0.018, and 19%
vs. 0% at 18 months, p = 0.023). In Stage IV patients, the prognosis was
not influenced by the type of radiotherapy. Multivariate analysis
revealed that a pretreatment carbohydrate antigen (CA) 19-9 level < 1000
U/ml was associated with better survival. In non-Stage IV patients with
a CA 19-9 level < 1000 U/ ml, EBRT + IORT appeared to produce a better
survival than EBRT alone (p = 0.047). This was supported by multivariate
analysis. CONCLUSION: High-dose IORT + EBRT may be more effective than
EBRT alone in patients with unresectable but localized pancreatic cancer
and a low CA 19-9 level.
20
UI - 11833495
AU - Martin RC; Klimstra DS; Brennan MF; Conlon KC
TI -
Solid-pseudopapillary tumor of the pancreas: a surgical enigma?
SO - Ann Surg Oncol 2002 Jan-Feb;9(1):35-40
AD - Gastric and Mixed Tumor Service, Department of Surgery, Memorial
Sloan-Kettering Cancer Center, New York, New York 10021, USA.
BACKGROUND: Solid-pseudopapillary tumors (SPTs) of the pancreas have
been reported as rare lesions with "low malignant potential" occurring
mainly in young women. This study was designed to define the
clinicopathological characteristics and the effect of surgical
2000 was performed. Clinicopathological, operative, and survival data
were obtained. The Kaplan-Meier method and chi2 analysis were performed.
All cases were re-reviewed by a senior pathologist. RESULTS: During this
time, 24 patients were diagnosed as having SPTs (0.9%). Twenty females
and four males were identified, with a median age of 39 years (range,
12-79). The median size of the lesions was 8.0 cm (range, 1-20). Two
patients' tumors were found to be unresectable at initial presentation
because of vascular invasion; both patients have remained alive with
disease, one for 13 years and the other 1 year. At a median follow-up of
8 years, one recurrence occurred in 17 patients who underwent complete
resection. Microscopic margin positive (P = .26), invasion of
surrounding structures (P = .51), and size >5 cm (P = .20) were not
significant predictors of survival. Four patients presented with
synchronous liver metastasis and underwent resection of the primary
tumor and the liver metastasis, with one patient dying of progression of
metastatic disease at 8 months, another alive with recurrence in the
liver at 6 years, and the last two alive without evidence of disease at
1 month and 11 years. CONCLUSIONS: SPT occurs predominantly in women
(82%), although it can occur in men; all age groups are affected.
Complete resection is associated with long-term survival even in the
presence of metastatic disease.
21
UI - 12094335
AU - Heinemann V
TI -
Present and future treatment of pancreatic cancer.
SO - Semin Oncol 2002 Jun;29(3 Suppl 9):23-31
AD - Department of Hematology/Oncology, Klinikum Grosshadern,
Ludwig-Maximilians-University of Munich, Munich, Germany.
Gemcitabine has become a new standard for treatment of advanced
pancreatic cancer. This development is based not only on drug efficacy
but also on a favorable side-effect profile. Combinations of gemcitabine
with antitumor drugs such as cisplatin, 5-fluorouracil, docetaxel,
irinotecan, oxaliplatin, or capecitabine, and biological agents such as
cetuximab or trastuzumab, have yielded promising results in phase II
trials. However, none of these combinations has yet reached the level of
an evidence-based standard treatment. Copyright 2002, Elsevier Science
(USA). All rights reserved.
22
UI - 12089997
AU - Plesa C; Bradea C; Strat V; Chifan V; Niculescu D; Tarcoveanu E;
TI -
Georgescu S; Danila N; Cotea E
[Cephalic duodenopancreatectomy with pyloric preservation in the
treatment of pancreatic cancer]
SO - Rev Med Chir Soc Med Nat Iasi 2000 Apr-Jun;104(2):89-92
AD - Facultatea de Medicina Clinica I Chirurgie, Universitatea de Medicina si
Farmacie Gr. T Popa, Iasi.
Is the application of DPCPP in the treatment of pancreatic neoplasia a
good reason? We have analysed 30 patients with cephalic
duodenopancreatectomy (DPC) for biliopancreatic neoplasia between
1995-1999 in Ist Surgical Clinic of Iassy (13 with pyloric
preservation). The indications were:--cephalic pancreatic neoplasia
(adenocarcinoma--4 cases (one with cephalic chronic pancreatitis on the
intraoperative microscopical examination);--Vater ampulloma (7
cases);--inferior common biliary duct (CBD 1 case);--duodenal
adenocarcinoma (1 case). In the same time was operated 265
biliopancreatic diseases (203 mechanical jaundice with 132 neoplastic
jaundice). RESULTS:--Better early postoperatively status of the
patients--DPCPP does not give better prognosis;--there are necessary
some technical skills to depase the important phases of DPCPP.
23
UI - 12077832
AU - Shoikhet IaN; Moskvitina LN; Slukhai EIu; Mar'ian AV; Smirnov AK
TI -
[Surgical treatment of malignant tumors in the biliopancreatoduodenal
zone]
SO - Khirurgiia (Mosk) 2002;(5):30-3
Results of surgical treatment of 381 patients with cancer of
biliopancreatoduodenal zone associated with obstructive jaundice were
analyzed. Mean level of bilirubinemia was 182 +/- 12 mcmol/l.
Cholecystoanastomosis was created in the majority of cases (51.4%).
Radical surgery was carried out in 31 patients. Postoperative
complications were seen in 155 (41%) patients. Renal-hepatic failure
(28.1%) and purulent-septic complications (25.2%) were dominant.
Lethality after radical operations was 12.9%, after palliative--15.7%.
Inhibiting effect of autoplasma on phagocytosis and decrease of
phagocytosis indexes 1.5-2 times are the risk factors of postoperative
purulent-septic complications development. Discrete plasmapheresis
reduces of postoperative purulent-septic complications rate.
24
UI - 12085203
AU - Ikeda M; Okada S; Tokuuye K; Ueno H; Okusaka T
TI -
A phase I trial of weekly gemcitabine and concurrent radiotherapy in
patients with locally advanced pancreatic cancer.
SO - Br J Cancer 2002 May 20;86(10):1551-4
AD - Hepatobiliary and Pancreatic Oncology Division, National Cancer Center
Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
This study investigated the maximum-tolerated dose of gemcitabine based
on the frequency of dose-limiting toxicities of weekly gemcitabine
treatment with concurrent radiotherapy in patients with locally advanced
pancreatic cancer. Fifteen patients with locally advanced pancreatic
cancer that was histologically confirmed as adenocarcinoma were enrolled
in this phase I trial of weekly gemcitabine (150-350 mg x m(-2)) with
concurrent radiotherapy (50.4 Gy in 28 fractions). Gemcitabine was
administered weekly as an intravenous 30-min infusion before
radiotherapy for 6 weeks. Three of six patients at the dose of 350 mg x
m(-2) of gemicitabine demonstrated dose-limiting toxicities involving
neutropenia/ leukocytopenia and elevated transaminase, while nine
patients at doses of 150 mg x m(-2) and 250 mg x m(-2) did not
demonstrate any sign of dose-limiting toxicity. Of all 15 enrolled
patients, six patients (40.0%) showed a partial response. More than 50%
reduction of serum carbohydrate antigen 19-9 level was observed in 13
(92.9%) of 14 patients who had pretreatment carbohydrate antigen 19-9
levels of 100 U x ml(-1) or greater. The maximum-tolerated dose of
weekly gemcitabine with concurrent radiotherapy was 250 mg x m(-2), and
this regimen may have substantial antitumour activity for patients with
locally advanced pancreatic cancer. A phase II trial of weekly
gemcitabine at the dose of 250 mg x m(-2) with concurrent radiation in
patients with locally advanced pancreatic cancer is now underway.
comCopyright 2002 Cancer Research UK
25
UI - 12093326
AU - Bradley EL 3rd
TI -
Pancreatoduodenectomy for pancreatic adenocarcinoma: triumph,
triumphalism, or transition?
SO - Arch Surg 2002 Jul;137(7):771-3; discussion 773
AD - 1600 Baywood Way, Sarasota, FL 34231, USA. ebradley10@home.com
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