scholarly journals Role of computed tomography in the determination of resectability of carcinoma pancreas

2019 ◽  
Vol 6 (11) ◽  
pp. 4068
Author(s):  
M. N. Sasikumar ◽  
Chintha Salam A.
Keyword(s):  
Computed Tomography ◽  
Pancreatic Cancer ◽  
Vascular Invasion ◽  
Survival Rates ◽  
Vascular Involvement ◽  
Borderline Resectable ◽  
Neoplastic Processes ◽  
Carcinoma Pancreas ◽  
Operative Findings

Background: Pancreatic cancer is one of the most aggressive neoplastic processes. Inspite of progress in the diagnosis and treatment of malignancies, the resectability and survival rates for pancreatic cancer are very poor. This study aims to determine the accuracy of computerised tomography in assessing the resectability of carcinoma pancreas.Methods: 66 patients with carcinoma pancreas, who were judged fit for surgery were studied. All cases had undergone preoperative contrast enhanced triphasic computed tomography (CT) for assessing the resectability. Radiological data was compared with per operative findings for assessments regarding vascular invasion and resectability.Results: Of the 66 cases, resectability reported by CT was 59 (89.4%). The rest of 7 (10.6%) cases were reported as unresectable. Per operatively vascular involvement was found in 14 (21.2%) cases and with no vascular invasion in 52 (78.8%) cases. All the unresectable cases reported in CT (7 cases) turned out to be unresectable. Out of 59 cases reported as resectable, 43 (65.2%) cases under went Whipples procedure, while rest of the 23 (34.8%) cases underwent palliative procedures. Out of these 23 cases, 14 (21.2%) cases were unresectable due to vascular involvement.Conclusions: The study has shown that CT does assess the operability in carcinoma pancreas, assessing mainly unresectability though less effective in assessing resectability. The role of endoscopic ultrasound and laparoscopic ultrasound in aiding CT in further assessment of resectable and borderline resectable cases are to be considered for further research.

The role of radiotherapy in locally advanced pancreatic cancer

2021 ◽  
pp. 20210044
Author(s):  
Florence Huguet ◽  
Victoire Dabout ◽  
Eleonor Rivin del Campo ◽  
Sébastien Gaujoux ◽  
Jean Baptiste Bachet
Keyword(s):  
Pancreatic Cancer ◽  
Radiation Therapy ◽  
Technical Progress ◽  
Vascular Invasion ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Metastatic Tumour ◽  
Borderline Resectable ◽  
Made In

At diagnosis, about 15% of patients with pancreatic cancer present with a resectable tumour, 50% have a metastatic tumour, and 35% a locally advanced tumour, non-metastatic but unresectable due to vascular invasion, or borderline resectable. Despite the technical progress made in the field of radiation therapy and the improvement of the efficacy of chemotherapy, the prognosis of these patients remains very poor. Recently, the role of radiation therapy in the management of pancreatic cancer has been much debated. This review aims to evaluate the role of radiation therapy for patients with locally advanced tumours.

scholarly journals The role of systemic therapy in localized pancreatic cancer (review)

2019 ◽  
Vol 24 (3) ◽  
pp. 65-72
Author(s):  
L. G. Zhukova ◽  
K. S. Grechukhina ◽  
S. A. Smolin ◽  
B. I. Bammatov
Keyword(s):  
Pancreatic Cancer ◽  
Surgical Oncology ◽  
Anticancer Therapy ◽  
Toxicity Profile ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Results Of Treatment ◽  
Cancer Review ◽  
New Concepts

The results of treatment of localized (early) pancreatic cancer are unsatisfactory despite all achievements of modern clinical and surgical oncology. Nevertheless, certain success was achieved even in these extremely unfavorable patients regarding their prognosis. The authors analyzed evolution of adjuvant therapy, as well as new concepts in the treatment of borderline resectable and resectable pancreatic cancer. Modern anticancer therapy with acceptable toxicity profile significantly improved the outcomes. However, further research is needed to improve the effectiveness of treatment despite favorable current results.

Full-Dose Gemcitabine With Concurrent Radiation Therapy in Patients With Nonmetastatic Pancreatic Cancer: A Multicenter Phase II Trial

2008 ◽  
Vol 26 (6) ◽  
pp. 942-947 ◽  
Author(s):  
William Small ◽  
Jordan Berlin ◽  
Gary M. Freedman ◽  
Theodore Lawrence ◽  
Mark S. Talamonti ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Survival Rates ◽  
Three Dimensional ◽  
Primary Objective ◽  
Borderline Resectable ◽  
Full Dose ◽  
Multicenter Phase ◽  
Grade 3 ◽  
One Year ◽  
3D Crt

Purpose Gemcitabine is effective in the treatment of pancreatic cancer and is a potent radiosensitizer. This study assessed safety and efficacy of full-dose gemcitabine administered before and during concurrent three-dimensional conformal radiation (3D-CRT) in patients with nonmetastatic pancreatic cancer. Patients and Methods During cycles 1 and 3, patients received gemcitabine at 1,000 mg/m2 on days 1 and 8 of each 21-day cycle. Cycle 2 included the same dose of gemcitabine on days 1, 8, and 15 of a 28-day cycle with concurrent 3D-CRT at 36 Gy, administered in 15 fractions of 2.4 Gy, over 3 weeks. Resectable patients underwent surgery 4 to 6 weeks after treatment. The primary objective was evaluation of toxicity. Tumor response, CA 19-9, and 1-year survival were also assessed. Results Forty-one patients enrolled at six institutions between April 2002 and October 2003. Among the 39 treated patients, the most common toxicities were grade 3 neutropenia (12.8%), grade 3 nausea (10.3%), and grade 3 vomiting (10.3%). The response rate was 5.1% and disease control rate was 84.6%. Mean post-treatment CA 19-9 levels (228 ± 347 U/mL) were significantly (P = .006) reduced compared with pretreatment levels (1,241 ± 2,124 U/mL). Thirteen (81%) of 16 patients initially judged resectable, three (33%) of nine borderline-resectable patients, and one (7%) of 14 unresectable patients underwent resection after therapy. One-year survival rates were 73% for all patients, 94% for resectable patients, 76% for borderline-resectable patients, and 47% for unresectable patients. Conclusion Full-dose gemcitabine with concurrent radiotherapy was well tolerated and active. Evaluation of this regimen in a larger, randomized trial for patients with resectable or borderline-resectable disease may be warranted.

Clinical outcomes in borderline resectable pancreatic cancer: A cohort study.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 494-494
Author(s):  
Davendra Sohal ◽  
Mohammad Altujjar ◽  
Katherine Tullio ◽  
Mohamed Abazeed ◽  
Robert James Pelley ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cohort Study ◽  
Surgical Resection ◽  
Cleveland Clinic ◽  
Pancreatic Head ◽  
Vascular Involvement ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Cross Sectional ◽  
Borderline Resectable Pancreatic Cancer

494 Background: The management of borderline resectable pancreatic cancer (BRPC) remains unsettled and the predictors of outcome are uncertain. We evaluated the role of neoadjuvant therapy (nRx) and outcomes in patients with BRPC. Methods: We conducted a retrospective cohort study of consecutive patients with BRPC who received nRx and were followed at the Cleveland Clinic. A histopathologic diagnosis of pancreatic carcinoma was required. Tumor anatomy was assessed by contrast-enhanced cross-sectional imaging (CT or MRI), and BRPC was defined as a tumor-vessel wall interface involving one or more of: celiac artery, superior mesenteric artery, common hepatic artery, main portal vein, superior mesenteric vein; making margin-negative resection unlikely. Baseline laparoscopy was performed to rule out occult metastatic disease. Chemotherapy (CT), radiation (RT), surgery details, and pathologic and survival outcomes were evaluated. Hazard ratios (HR) with 95% confidence intervals (CI) and 2-sided p-values are presented. Results: The study population comprised 79 patients from 2009 to 2014. Median age was 64 years; 52% were male; 85% were Caucasian. Pancreatic head/neck were the primary site in 81%; body/tail in 19%. Vascular involvement included arterial in 32 (41%), and venous in 65 (82%) patients. nRx included RT in all patients; 77 (97%) received CT; gemcitabine (n = 50, 63%) was the most common agent. After CT/RT, 36 (46%) patients had unresectable/inoperable disease: 29 (37%) for anatomic reasons, 4 (5%) for physiologic reasons, and 3 (4%) for both. Surgical resection was performed in 43 (54%) patients; 38 (88%) had negative margins; 30 (70%) had negative nodes; 32 (74%) received adjuvant CT. There were no statistically significant predictors of resection. After median follow-up of 27 mths, there have been 45 deaths (57%); median overall survival (mOS) is 23.5 mths (95% CI: 16-28 mths). Only cancer resection was associated with survival (mOS, resected: not reached; mOS, not resected: 12.8 mths; HR: 0.30, 95% CI: 0.16-0.56, p = 0.0002). Conclusions: Surgical resection, if feasible, of BRPC is associated with improved OS. Strategies to improve the odds of resection should be evaluated in prospective studies.

Mo1347 ROLE OF COMPUTED TOMOGRAPHY IN THE EARLY DETECTION OF PANCREATIC CANCER: BENEFIT BEYOND LEAD TIME

2020 ◽  
Vol 158 (6) ◽  
pp. S-858-S-859
Author(s):  
Dhruv P. Singh ◽  
Sushil Kumar Garg ◽  
Michael L. Wells ◽  
Ajit H. Goenka ◽  
Shannon P. Sheedy ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pancreatic Cancer ◽  
Early Detection ◽  
Lead Time

Localized Pancreatic Cancer: Multidisciplinary Management

2016 ◽  
pp. e217-e226 ◽  
Author(s):  
Andrew L. Coveler ◽  
Joseph M. Herman ◽  
Diane M. Simeone ◽  
E. Gabriela Chiorean
Keyword(s):  
Pancreatic Cancer ◽  
Biomarker Discovery ◽  
Locally Advanced ◽  
Optimal Treatment ◽  
Treatment Modalities ◽  
Vascular Involvement ◽  
Single Digit ◽  
Borderline Resectable ◽  
Unresectable Disease ◽  
Tumor Boards

Pancreatic cancer is an aggressive cancer that continues to have single-digit 5-year mortality rates despite advancements in the field. Surgery remains the only curative treatment; however, most patients present with late-stage disease deemed unresectable, either due to extensive local vascular involvement or the presence of distant metastasis. Resection guidelines that include a borderline resectable group, as well as advancements in neoadjuvant chemotherapy and radiation that improve resectability of locally advanced disease, may improve outcomes for patients with more invasive disease. Multi-agent chemotherapy regimens fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) and nab-paclitaxel with gemcitabine improved response rates and survival in metastatic pancreatic cancer and are now being used in earlier stages for patients with localized potentially resectable and unresectable disease, with goals of downstaging tumors to allow margin-negative resection and reducing systemic recurrence. Chemoradiotherapy, although still controversial for both resectable and unresectable pancreatic cancer, is being used in the context of contemporary chemotherapy backbone regimens, and novel radiation techniques such as stereotactic body frame radiation therapy (SBRT) are studied on the premise of maintaining or improving efficacy and reducing treatment duration. Patient selection for optimal treatment designation is currently provided by multidisciplinary tumor boards, but biomarker discovery, in blood, tumors, or through novel imaging, is an area of intense research. Results to date suggest that some patients with unresectable disease at the outset have survival rates as good as those with initially resectable disease if able to undergo surgical resection. Long-term follow-up and improved clinical trials options are needed to determine optimal treatment modalities for patients with localized pancreatic cancer.

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