Locally Advanced Pancreatic Cancer

2005 ◽  
Vol 23 (20) ◽  
pp. 4538-4544 ◽  
Author(s):  
Christopher G. Willett ◽  
Brian G. Czito ◽  
Johanna C. Bendell ◽  
David P. Ryan
Keyword(s):  
United States ◽  
Pancreatic Cancer ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
The United States ◽  
External Beam ◽  
Targeted Agents ◽  
Beam Irradiation ◽  
External Beam Irradiation

Of the 32,180 patients diagnosed with pancreatic carcinoma in the United States this year, approximately 40% will present with locally advanced disease. Radiotherapeutic approaches are often employed because these patients have unresectable tumors by virtue of local invasion into the retroperitoneal vessels in the absence of clinically detectable metastases. These treatments include external-beam irradiation with and without fluorouracil-based chemotherapy, intraoperative irradiation, and, more recently, external-beam irradiation with new systemic targeted agents.

Intraoperative and external beam irradiation ± 5-FU for locally advanced pancreatic cancer

1987 ◽  
Vol 13 (3) ◽  
pp. 319-329 ◽  
Author(s):  
Leonard L. Gunderson ◽  
J.Kirk Martin ◽  
Larry K. Kvols ◽  
David M. Nagorney ◽  
Jennifer M. Fieck ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Locally Advanced Pancreatic Cancer ◽  
External Beam ◽  
Beam Irradiation ◽  
External Beam Irradiation

scholarly journals External beam versus intraoperative and external beam irradiation for locally advanced pancreatic cancer

Cancer ◽  
1988 ◽  
Vol 61 (6) ◽  
pp. 1110-1116 ◽  
Author(s):  
Graciela E. Roldan ◽  
Leonard L. Gunderson ◽  
David M. Nagorney ◽  
J. Kirk Martin ◽  
Duane M. Ilstrup ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Locally Advanced Pancreatic Cancer ◽  
External Beam ◽  
Beam Irradiation ◽  
External Beam Irradiation

scholarly journals Novel Approaches for Concurrent Irradiation in Locally Advanced Cervical Cancer: Platinum Combinations, Non-Platinum-Containing Regimens, and Molecular Targeted Agents

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Giannis Mountzios ◽  
Aspasia Soultati ◽  
Dimitrios Pectasides ◽  
Meletios A. Dimopoulos ◽  
Christos A. Papadimitriou
Keyword(s):  
Clinical Trials ◽  
Locally Advanced ◽  
Concurrent Chemoradiation ◽  
External Beam ◽  
Targeted Agents ◽  
Platinum Compounds ◽  
Beam Irradiation ◽  
External Beam Irradiation ◽  
Molecular Targeted Agents

Despite the available prevention and early detection strategies, squamous-cell carcinoma of the uterine cervix is still diagnosed as locally advanced disease in a considerable proportion of patients. As a potent sensitizer of cancer cells, cisplatin has been the “traditional partner” of external beam irradiation in this setting for more than two decades. Induction chemotherapy strategies followed by concurrent chemoradiation or surgery and preoperative concurrent chemoradiation have been recently implemented in clinical trials in an effort to optimize local control and to minimize the risk of distant metastases. In this context, cisplatin has been combined with a number of other potential radiosensitizers, including 5-fluorouracil, capecitabine, and gemcitabine. In patients resistant or intolerant to platinum compounds, numerous non-platinum-containing regimens have been developed, implementing various antimetabolites, taxanes, antineoplastic antibiotics, and topoisomerase II inhibitors. More recently, molecular agents targeting critical pathways in cervical malignant transformation are being assessed in early clinical trials in combination with external-beam irradiation. In the current work, we review the evolving role of cisplatin and other platinum compounds, either alone or in combination regimens, in the context of other potent radiosensitizers. The emerging role of molecular targeted agents, as candidate partners of external beam irradiation, is also discussed.

Combination chemotherapy for locally advanced pancreatic cancer: equivalence to external beam irradiation and implication for future management.

1983 ◽  
Vol 1 (7) ◽  
pp. 413-415 ◽  
Author(s):  
F P Smith ◽  
D Stablein ◽  
S Korsmeyer ◽  
J Neefe ◽  
B K Chun ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Combination Chemotherapy ◽  
Randomized Trials ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Locally Advanced Pancreatic Cancer ◽  
Beam Irradiation ◽  
External Beam Irradiation ◽  
Disseminated Disease ◽  
Future Management

Chemotherapy with 5-fluorouracil, doxorubicin, and mitomycin-C was administered to 17 patients with locally advanced pancreatic cancer. The median survival for these patients was 8 months. With a multiaxial retrospective analysis, the overall survival of this study group appears to be least equivalent to that reported with 6,000 photon rad alone or of neutrons, and compares favorably to that achieved with combined 6,000 photo rad plus 5-fluorouracil. Of 15 relapses, only 4 had presented with evidence of disseminated disease. Based upon this analysis we recommend additional studies of combination chemotherapy with radiation therapy in future prospective randomized trials.

Management of Borderline Resectable and Locally Advanced Pancreatic Adenocarcinoma

2019 ◽  
Author(s):  
Francis Igor Macedo ◽  
Danny Yakoub ◽  
Vikas Dudeja ◽  
Nipun B. Merchant
Keyword(s):  
Pancreatic Cancer ◽  
Neoadjuvant Therapy ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
The United States ◽  
Locally Advanced Pancreatic Cancer ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Borderline Resectable Pancreatic Cancer ◽  
Number Of Patients

The incidence of pancreatic cancer continues to rise, and it is now the third-leading cause of cancer-related deaths in the United States. Only 15 to 20% of patients are eligible to undergo potentially curative resection, as most tumors are deemed unresectable at the time of diagnosis because of either locally advanced disease or distant metastases. Improvements in preoperative CT imaging have enabled better determination of the extent of disease and allowed for better operative planning. Based on their relationship to the surrounding vasculature and structures and presence or absence of distant disease, pancreatic tumors are classified into four categories: resectable, borderline resectable pancreatic cancer (BRPC), locally advanced pancreatic cancer (LAPC), and metastatic. With the recent advent of more effective chemotherapy regimens, efforts have focused on using neoadjuvant therapy approaches to increase the likelihood of achieving an R0 in patients with BRPC and possibly convert unresectable, locally advanced tumors to potentially resectable tumors. Response with neoadjuvant therapy regimens has resulted in increased number of patients eligible for resection, many times requiring vascular resection. Herein, we describe recent changes in the classification, important surgical and pathologic considerations and updated multimodal therapeutic options in the complex management of BRPC and LAPC.  This review contains 5 figures, 2 tables, and 78 references. Key Words: borderline resectable pancreatic cancer, CA 19-9, FOLFIRINOX, locally advanced pancreatic cancer, nab-paclitaxel, neoadjuvant chemotherapy, pancreatectomy, portal vein resection, radiation therapy, gemcitabine

Irreversible Electroporation: Expanding the Armamentarium against Pancreatic Cancer

2019 ◽  
Vol 03 (02) ◽  
pp. 138-142
Author(s):  
Gray R. Lyons ◽  
Brian J. Schiro ◽  
Govindarajan Narayanan
Keyword(s):  
Pancreatic Cancer ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Irreversible Electroporation ◽  
Treatment Algorithm ◽  
Advanced Pancreatic Cancer ◽  
Invasive Approach ◽  
Anticancer Treatment ◽  
Minimal Damage

AbstractLocally advanced pancreatic cancer is often refractory to conventional therapy, thus warranting new approaches. Irreversible electroporation is an ablative modality that has the potential to deliver targeted anticancer treatment with minimal damage to surrounding structures. Indications for irreversible electroporation in pancreatic cancer patients include palliation for metastatic disease, downstaging for surgery in locally advanced disease, and treatment of local recurrence following operative resection. Benefits of the modality in pancreatic cancer include a minimally invasive approach, precise delivery that minimizes nontarget ablation, and upregulation of anticancer immune response. Early studies have demonstrated an acceptable safety profile for irreversible electroporation; however, more data are needed to define the role of IRE in the treatment algorithm of pancreatic cancer.

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