National Cancer Institute®
Last Modified: July 1, 2002
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.
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.
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.
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
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.
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. email@example.com
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.
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.
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
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.
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.
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.
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. firstname.lastname@example.org
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.
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.
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. email@example.com
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
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. firstname.lastname@example.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.
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.
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.
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%.
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.
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.
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.
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.
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.
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
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. email@example.com
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